Patient Care and Financial Responsibility AgreementPatient Care and Financial Responsibility Agreement • September 23rd, 2021
Welcome!Patient Care and Financial Responsibility Agreement • July 14th, 2021
Patient Care and Financial Responsibility AgreementPatient Care and Financial Responsibility Agreement • April 11th, 2024
By my signature or electronic signature below, I voluntarily consent that I (or my child) will participate in a mental health evaluation and treatment by clinical staff at Gladstone Psychiatry & Wellness, LLC. I understand that the practice of psychiatry is not an exact science, and that there are risks and benefits associated with receiving psychiatric treatment. I acknowledge and agree that no guarantees are made to me concerning the results and outcomes of the mental health evaluation and treatment rendered to me (or my child) by the clinical staff at Gladstone Psychiatry & Wellness, LLC. Please review the Detailed Explanation of Consent for Psychiatric Evaluation and Treatment document on pages 5-6 of this document for further details. I understand that Gladstone does not offer crisis services, operate on a 24/7 basis, or maintain on-call providers. In the event of an emergency, I will proceed to the nearest emergency room or dial 9-1-1 immediately.
Welcome!Patient Care and Financial Responsibility Agreement • July 14th, 2021
