Junior Informed Consent Form (Age 18 years and under)Informed Consent Form • August 15th, 2016
Contract Type FiledAugust 15th, 2016
Agreement to be in the StudyInformed Consent Form • January 14th, 2020
Contract Type FiledJanuary 14th, 2020
Attachment B: Informed Consent FormsInformed Consent Form • June 23rd, 2020
Contract Type FiledJune 23rd, 2020The informed consent forms for the random assignment and non-random assignment grantees are included here respectively.
Department of Psychology Minnesota State University Moorhead Informed Consent FormInformed Consent Form • January 2nd, 2020
Contract Type FiledJanuary 2nd, 2020Purpose of the study: We hope to learn what types of information influence the spoken word recognition process and how presentation conditions affect word recognition.
ANEW PSYCHOLOGICAL SERVICES, PLLCInformed Consent Form • February 18th, 2020
Contract Type FiledFebruary 18th, 2020Welcome to Anew Psychological Services, PLLC. This document contains important information about our 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.
Collateral Reference Informed Consent FormInformed Consent Form • February 27th, 2018
Contract Type FiledFebruary 27th, 2018By signing this Agreement, I give my consent for the psychologist to be at liberty to request and receive information from myself in the conduct of this assessment. This process will be deemed as open indicating that any information obtained while working with the individuals or family may be used by the assessor in the report that may be provided to both parties or the court through their counsel (if applicable) upon completion of the process.
Adult ParticipantInformed Consent Form • April 11th, 2017
Contract Type FiledApril 11th, 2017I, the undersigned, being at least 18 years of age, and for myself, my personal representatives, my estate, heirs, and next of kin, and in consideration for the opportunity to participate in the event described below do hereby sign this waiver, release and indemnity agreement. I certify that I have reviewed this agreement and sign it voluntarily of my own free will.
Attachment B: Informed Consent FormsInformed Consent Form • January 25th, 2016
Contract Type FiledJanuary 25th, 2016The informed consent forms for the random assignment and non-random assignment grantees are included here respectively.
Adolescent Informed Consent Form & Parent Agreement to Respect PrivacyInformed Consent Form • November 9th, 2010
Contract Type FiledNovember 9th, 2010The purpose of meeting with a psychologist is to get help with problems or processes that are bothering you or interfering with being successful in important areas of life. You may have asked to meet with and talk to a therapist or this could have occurred because your parents, teachers, doctor or someone else has concerns about you. The process of therapy involves getting to know your perspective on these difficulties or predicaments in your life, developing an understanding of the nature of the difficulties, and generating better ways to cope with or manage those difficulties. Sometimes the predicament will disappear altogether, but other times learning to manage or cope with difficulties is a good outcome.
Ryerson University Consent AgreementInformed Consent Form • November 26th, 2021
Contract Type FiledNovember 26th, 2021You are being invited to participate in a research study. Please read this consent form so that you understand what your participation will involve. Before you consent to participate, please feel free to email any questions you have to the co-investigators (Dr. Adiel Mallik, Zoe Thomson) to be sure you understand what your participation will involve. The co-investigators (Dr. Adiel Mallik, Zoe Thomson) and/or the research assistant will be facilitating the consent process.
Department of Psychology Minnesota State University Moorhead Informed Consent FormInformed Consent Form • September 13th, 2021
Contract Type FiledSeptember 13th, 2021Purpose of the study: We hope to learn what types of information influence the spoken word recognition process and how presentation conditions affect word recognition.
Agreement to be in the StudyInformed Consent Form • July 27th, 2020
Contract Type FiledJuly 27th, 2020You (“you” refers to you or your child throughout this consent form) are invited to take part in research using your medical data. Because you have systemic lupus erythematosus (SLE) or another form of lupus, you are uniquely positioned to help advance disease understanding and care. This document describes the purpose of this research study and how your data will be used, so that you can make an informed decision about participating in the study. Please take your time to read the following
EDIInformed Consent Form • August 22nd, 2023
Contract Type FiledAugust 22nd, 2023
PROVIDER-CLIENT AGREEMENT:Informed Consent Form • September 7th, 2022
Contract Type FiledSeptember 7th, 2022This document contains important information about our professional services and business policies. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign this or at any time in the future.
INFORMED CONSENT AND ASSUMPTION OF RISK AGREEMENT (to be executed byInformed Consent Form • April 25th, 2023
Contract Type FiledApril 25th, 2023
Informed Consent FormInformed Consent Form • June 14th, 2018
Contract Type FiledJune 14th, 2018This document contains important information about Targeted Hypnotherapy’s professional services and business policies. It details privacy protections, patient rights and provisions, and explains how this Practice uses and handles your Personal Information for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them.
WRITTEN INFORMED CONSENT FORM (USE ONE FORM PER PARTICIPANT)Informed Consent Form • February 11th, 2020
Contract Type FiledFebruary 11th, 2020
Adult ParticipantInformed Consent Form • May 10th, 2018
Contract Type FiledMay 10th, 2018I, the undersigned, being at least 18 years of age, and for myself, my personal representatives, my estate, heirs, and next of kin, and in consideration for the opportunity to participate in the event described below do hereby sign this waiver, release and indemnity agreement. I certify that I have reviewed this agreement and sign it voluntarily of my own free will.
Junior Informed Consent Form (Age 18 years and under)Informed Consent Form • May 11th, 2016
Contract Type FiledMay 11th, 2016
This agreement is between Hanlie Boshoff, Narrative Counsellor in private practiseInformed Consent Form • August 10th, 2020
Contract Type FiledAugust 10th, 2020
Relationship Coaching Informed Consent FormInformed Consent Form • January 12th, 2022
Contract Type FiledJanuary 12th, 2022Description of Service: Coaching is a relationship between a coach and the client. This Agreement is for coaching by Mr. Jay (hereinafter, the “Coach”). My Jay’s has a counseling educational background and has experience is in a broad range of areas, and he uses his own experience over the years in coaching. While there may be other issues as depression, ADHD, and anxiety that will be discussed during the relationship, this Coaching relationship may not be best suited for dealing with complex psychological issues. For those issues and at any time, you (hereinafter, the “Client”) may see a licensed mental health professional for such cure, therapy, and/or treatment. In commencing this Coaching relationship, you are agreeing that you understand the above and that you will be responsible for getting other treatment as needed separately through licensed therapists if needed.