INFORMED CONSENT FOR SERVICESInformed Consent for Services • January 23rd, 2019 • North Carolina
Please review this agreement carefully, as it sets forth the understanding between you (“Client”) and the Kellin, Foundation regarding the services you have requested and we will provide for you. If you have any questions, concerns or issues about the content of this Agreement please contact us for clarification before signing it.
INFORMED CONSENT FOR SERVICESInformed Consent for Services • August 12th, 2024
INFORMED CONSENT FOR SERVICESInformed Consent for Services • July 24th, 2019
WholePerson Therapeutics provide occupational therapy services which include physical rehabilitation, health and wellness, environmental modification, pain management, chronic condition management, and more… Our services involve the use of many different types of evaluations, equipment, and treatment approaches. We utilize a variety of techniques, interventions and modalities to help us to try and improve your function. As with any treatment of human conditions, there are benefits and risks involved with licensed therapeutic services.
INFORMED CONSENT FOR SERVICESInformed Consent for Services • May 27th, 2018 • North Carolina
Please review this agreement carefully, as it sets forth the understanding between you (“Client”) and the Kellin, PLLC and/or Kellin Foundation (“Agency”) regarding the services you have requested and we will provide for you. If you have any questions, concerns or issues about the content of this Agreement please contact us for clarification before signing it.
Ella Deaver Counseling, LCSWA, LCASA, PLLC Informed Consent For ServicesInformed Consent for Services • September 7th, 2022
Client Information Full Name: Date of Birth: Age: Address: Home Phone: Mobile Phone: Email Address: Who referred you to Ms. Deaver?:
INFORMED CONSENT FOR SERVICES Contract for Services and TreatmentInformed Consent for Services • July 15th, 2021
INFORMED CONSENT FOR SERVICESInformed Consent for Services • September 28th, 2023
