Consent to TreatmentConsent to Treatment • October 4th, 2013
For Crystal A. McComas, LSCSW, LLC to provide services to you, your minor child, or your ward, you must read and sign this Consent to Treatment form. Please be advised that this form is not a contract or agreement for services. This form simply allows Crystal A. McComas, LSCSW, and LLC to provide services to you, your minor child, or your ward. You may withdraw this consent to treatment at any time and ask that your file be closed.
AUTHORIZATIONS & AGREEMENTSConsent to Treatment • June 29th, 2017
testing, appropriate immunizations, medical treatment and treatment with controlled substances. I may be tested for HIV (the virus that causes AIDS), hepatitis and other diseases. My consent covers care from the agents, employees and medical staff of the University of Kentucky. No one has guaranteed me that the medical care will have certain results. I have the right (i) to make decisions about my health care, (ii) to refuse medical care, and (iii) to revoke this consent at any time except to the extent medical care has already been provided. The patient or the authorized parent, guardian, responsible party or surrogate of the patient must give consent.
Consent to TreatmentConsent to Treatment • February 11th, 2022
Welcome to my practice. This document contains important information about my professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations.
Consent To TreatmentConsent to Treatment • August 15th, 2016
The purpose of this agreement is to provide important information about the policies and procedures of my practice. Psychotherapy is more likely to be successful if we have a mutual understanding of the counseling process.
Consent to TreatmentConsent to Treatment • October 5th, 2020
Fayetteville, AR 72701Consent to Treatment • July 13th, 2015
Christine A. Volker, Ph.D.Consent to Treatment • August 3rd, 2010
Dr. Volker is a sole practitioner operating in a shared office space. The other practitioners in the office suite have no relation to Dr. Volker’s practice and share no business or legal liability with Dr. Volker. Dr. Volker holds licenses in Clinical Psychology, PSY18161, in Marriage and Family Therapy, MFT29746 and holds a master’s degree in Clinical Art Therapy.
CONSENT TO TREAT AND BENEFITS AND RISKS OF TREATMENTConsent to Treatment • May 25th, 2021
AUTHORIZATIONS & AGREEMENTSConsent to Treatment • August 30th, 2018
testing, appropriate immunizations, medical treatment and treatment with controlled substances. I may be tested for HIV (the virus that causes AIDS), hepatitis and other diseases. My consent covers care from the agents, employees and medical staff of the University of Kentucky. No one has guaranteed me that the medical care will have certain results. I have the right (i) to make decisions about my health care, (ii) to refuse medical care, and (iii) to revoke this consent at any time except to the extent medical care has already been provided. The patient or the authorized parent, guardian, responsible party or surrogate of the patient must give consent.
Consent to TreatmentConsent to Treatment • November 10th, 2015
Carolyn Breaud is licensed as a Marriage and Family Therapist (LMFT), to work with individuals, children and families. Her therapeutic modality is eclectic, although she is primarily solution-focused and behaviorally based. She often modifies her approach to suit the needs of the client and continues to monitor progress throughout therapy.
CONSENT TO TREATMENTConsent to Treatment • April 9th, 2020
Welcome to the Center for Individual & Family Therapy, a Christian counseling center. The following is an agreement to enter in to an INITIAL INTAKE/TREATMENT PROCESS.
CONSENT TO TREATMENTConsent to Treatment • November 3rd, 2021
The purpose of this agreement is to provide important information about the policies and procedures of my practice. Psychotherapy is more likely to be successful if we have a mutual understanding of the counseling process.
