Agreement to and Informed Consent for Psychological Treatment and for Uses and Disclosures to Carry Out Treatment, Payment, and Health CareInformed Consent for Psychological Treatment • February 22nd, 2021
This document contains important information about Dr. Gretchen Kubacky’s professional services and business policies. Please read it carefully. When you sign this document, it will represent an agreement between you and Dr. Gretchen Kubacky. Please refer to the Notice of Privacy Practices for important additional information.
ROSE CITY CENTERInformed Consent for Psychological Treatment • August 29th, 2020
This document contains important information about Rose City’s professional services and business policies. Please read it carefully. Your first session at Rose City is a consultation to assess whether or not we would recommend our services to you. Once this document has been signed by you, your therapist and his/her supervisor, you enter a contractual agreement between you and Rose City. Please refer to the Notice of Privacy Practices for important additional information.
