Fee Agreement/Consent to Treatment Sample Contracts

Fee Agreement/Consent to Treatment
Fee Agreement/Consent to Treatment • November 18th, 2020

This agreement describes the fees and policies of Heart to Heart Counseling, LLC. Alterations or modifications of this agreement are not allowed. All sections requiring your acknowledgment and/or signature must be completed before therapy services can be provided. A copy of this fee agreement is available at your request.

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Brenda Patton, LISW, LLC
Fee Agreement/Consent to Treatment • January 22nd, 2011

Welcome, my name is Brenda Patton, LISW, LLC. The purpose of the information in this packet is to inform you of the policies of our practice. To ensure that you have read, understood and agreed to these policies, your signature is required on the second page. A copy of this policy is available at your request.

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