AGREEMENT FOR SERVICE/INFORMED CONSENT - MINORAgreement for Service/Informed Consent - Minor • January 24th, 2020
This Agreement has been created for the purpose of outlining the terms and conditions of services for the minor child(ren) [Client name] (herein referred to as “Client”) and is intended to provide [name of parent/legal guardian] (herein referred to as Representative) with important information regarding the practices, policies and procedures of The Living Success Center (herein referred to as the "Clinic"), and the Clinician named above (herein referred to as the “Clinician”) and to clarify the terms of the professional therapeutic relationship between the Clinician and the Client. Any questions or concerns regarding the contents of the Agreement should be discussed with the Clinician prior to signing it.
