Cathexis Tucson, LLC. - Psychotherapy and Counseling Service Agreement (Includes Client Rights and Responsibilities, HIPAA Privacy Statement, Consent for Telehealth Services and Release of Information Consent)Psychotherapy and Counseling Service Agreement • January 28th, 2021
By signing this Agreement, you are consenting to enter a therapeutic relationship with Cathexis. You can revoke this Agreement at any time. If you decide to end the treatment relationship, please consult with your therapist about your desire to do so. That revocation will be binding on Cathexis, unless this agency has taken action in reliance on it, if there are obligations imposed on this agency by your health insurance in order to process or substantiate claims made under your policy or if you have not satisfied any financial obligations you have incurred. This consent to treat will expire 12 months from the date of signature, unless otherwise specified.
