CHILD CLINICAL SERVICES AGREEMENT Please read and sign this for your child/wardChild Clinical Services Agreement • November 10th, 2021
Clinical services at the BYU Comprehensive Clinic (the “Clinic”) are provided by graduate students in Marriage and Family Therapy, Clinical Psychology, and Social Work. These student-therapists are under the direct supervision of licensed therapists who are members of the BYU faculty. We provide individual, couple, family, and group therapy, along with psychological assessments. If you become aware that you have a community relationship with someone in the Clinic that may impact your services, please discuss this with your therapist or assessor. The supervisor for your case can be reached through the receptionist at (801) 422-7759. By signing this agreement, you acknowledge that your records will be shared with therapists and supervisors in the Clinic when your case is transferred or re-activated, when you are receiving services from more than one service provider at a time at the Clinic, or when you seek services here in the future.
