Agreement and Consent to TreatmentConsent to Treatment Agreement • December 20th, 2021
Contract Type FiledDecember 20th, 2021signature below indicates that I have read and discussed the agreement; it does not indicate that I am waiving any of my rights. I understand that any of the points mentioned can be discussed and may be open to change. If at any time during the services I receive, I have questions about any of the subjects discussed on the Policies and Procedures document, this document, or the HIPAA Notice of Privacy document, I can talk with my provider about them, and he/she will do their best to answer them.