Common Contracts
2 similar null contracts
Informed Consent and Practice PoliciesOctober 14th, 2020
The Washington Administrative Code requires that I, Greg Kiper, SUDP, LMHC, inform you of the form of treatment I provide, my fee, and educational background, including experience. This document provides you with important information about my professional services and office policies. Although it may seem like a lot of information, it is very important for you to carefully read this agreement and the other handouts I have included so we can discuss any questions you may have. At the end of this document, I have asked you to sign it indicating that you have read, understand and accept this agreement and the other documents I have included with it. You can revoke this agreement in writing at any time. Generally, I will consider your written revocation request as binding except in a few circumstances. These are: (1) If I have taken action in reliance on the agreement; (2) if you have not satisfied financial obligations you have incurred with me.
Informed Consent and Practice PoliciesDecember 31st, 2018
The Washington Administrative Code requires that I, Greg Kiper, CDP, LMHC, inform you of the form of treatment I provide, my fee, and educational background, including experience. This document provides you with important information about my professional services and office policies. Although it may seem like a lot of information, it is very important for you to carefully read this agreement and the other handouts I have included so we can discuss any questions you may have. At the end of this document, I have asked you to sign it indicating that you have read, understand and accept this agreement and the other documents I have included with it. You can revoke this agreement in writing at any time. Generally, I will consider your written revocation request as binding except in a few circumstances. These are: (1) If I have taken action in reliance on the agreement; (2) if you have not satisfied financial obligations you have incurred with me.
