Common Contracts
1 similar Service and Payment Agreement contracts
SERVICE AND PAYMENT AGREEMENTService and Payment Agreement • April 22nd, 2015
Authorization for Services: By virtue of my signature below, the undersigned hereby authorizes Beth Osten & Associates to provide such assessment and treatment services as may be deemed necessary and advisable for my child. The undersigned (individually referred to herein as “I”) reserve the right to refuse consent in the future to any proposed procedure or service.
