Disclosure Statement and Agreement Sample Contracts

Disclosure Statement and Agreement

Disclosure Statement and Agreement • October 8th, 2020

• Contract Type
  Disclosure Statement and Agreement
• Filed
  October 8th, 2020

Thank you for allowing Alyssa Najera and Associates, a Licensed Clinical Social Worker Corporation DBA Small Town Counseling CA, Inc. to be part of your mental health team. We are a Licensed Clinical Social Worker Corporation that provides mental health/therapy services. This document is intended to provide information to you regarding your treatment. Please read the entire document carefully and be sure to ask your therapist any questions that you may have regarding its contents.

Contract

Disclosure Statement and Agreement • January 30th, 2020 • California

• Contract Type
  Disclosure Statement and Agreement
• Filed
  January 30th, 2020
• Jurisdiction
  California

IMPORTANT: This Agreement contains full and complete disclosure of all rates and charges applicable to First U.S. Community Credit Union’s Platinum Visa and Platinum Preferred Visa and the terms of the Agreement for use of the Platinum and Platinum Preferred Visa cards.