AGREEMENT FOR SERVICE/INFORMED CONSENTService Agreement • January 2nd, 2022
Contract Type FiledJanuary 2nd, 2022This agreement is intended to provide herein “Patient(s)”) with important information regarding the practices, policies, and procedures of Negeen Moussavian, MA, Registered Associate Marriage & Family Therapist #107771 (herein “Therapist”), working under the supervision of Curt Widhalm, LMFT #47333, and to clarify the terms of the professional therapeutic relationship between Therapist and Patient(s). Any questions or concerns regarding the contents of this agreement should be discussed with the Therapist prior to signing it.