AGREEMENT FOR SERVICE / INFORMED CONSENT FOR ADULTSService Agreement • June 5th, 2019
Contract Type FiledJune 5th, 2019This Agreement is intended to provide [name of patient (herein “Patient”) with important information regarding the practices, policies and procedures of Daniel Powell, M.A., MFT, BCBA “Powell Therapy” (herein “Therapist”), and to clarify the terms of the professional therapeutic relationship between Therapist and Patient. Any questions or concerns regarding the contents of this Agreement should be discussed with Therapist prior to signing it.