AGREEMENT FOR SERVICES/INFORMED CONSENTAgreement for Services/Informed Consent • August 3rd, 2022
This Agreement is intended to inform you, the Client, of my practices, policies, and procedures, and to clarify the terms of the professional therapeutic relationship between us. You may revoke/cancel this Agreement in writing at any time. That revocation will terminate our therapeutic relationship and will be binding, unless I have already relied on this Agreement to take legal action or if you have not paid your bill in full. If you have any questions or concerns regarding the contents of this Agreement, please be sure to discuss them with me before signing it.
Phone: 760-636-8680~Email: karen@karendobbinsmft.comAgreement for Services & Informed Consent • November 25th, 2020
This document is intended to provide important information to you regarding your treatment. Please read the entire document carefully and be sure to ask any questions that you have regarding its contents.
Agreement For Services/Informed ConsentAgreement for Services/Informed Consent • March 11th, 2018
(herein “Therapist”), and to clarify the terms of the professional therapeutic relationship between Therapist and Client. Any questions or concerns regarding the contents of this Agreement should be discussed with Therapist prior to signing it.
Agreement for Services/Informed ConsentAgreement for Services/Informed Consent • July 1st, 2020
Process Therapy Institute, Inc. (herein “PTI”) is a non-profit, tax- exempt, charitable educational institution. We train our students in the concepts, skills, and art of being a psychotherapist.
Rebecca Picard, LMFT Psychotherapist 45121 Ukiah Street, Suite C Mendocino, CA 95460Agreement for Services/Informed Consent • May 15th, 2020
Introduction. This agreement is intended to provide ______________________ (“the client” or “you”) with important information regarding the services of and therapy relationship with Rebecca Picard, M.A. (“therapist”), Licensed Marriage and Family Therapist #112212. The client is welcome to ask questions about Rebecca Picard’s background and orientation or about any aspect of this agreement at any time.
Agreement for Services/ Informed ConsentAgreement for Services/ Informed Consent • January 10th, 2018
This agreement is intended to provide [name of Client] (herein “Client”) with important information regarding the practices, policies and procedures of HOPE Counseling Center, a non-profit agency, and to clarify the terms of the professional therapeutic relationship between Therapist and Client. Any questions or concerns regarding the contents of this Agreement should be discussed prior to signing it.
Agr e e m e nt For Ser v i c e /Inf or m e d Cons e ntAgreement for Services/ Informed Consent • April 12th, 2023
Welcome to my practice. This agreement is intended to provide you with important information about my professional services and business policies. Debra Sloss. LMFT will herein be referred to as “Therapist” and you will be referred to as “Client.” Please read this document carefully and bring any questions or concerns you have so that we can discuss those at our first meeting.
Agreement for Services/Informed ConsentAgreement for Services/Informed Consent • June 4th, 2020
AGREEMENT FOR SERVICES/INFORMED CONSENTAgreement for Services/Informed Consent • November 8th, 2020
This agreement is intended to provide important information to you (Client) regarding the practices, policies, and procedures of Elizabeth W. LaBolt, LMFT, License No.
