Form13 - FORM 13 —Use the top of this page for your...

Info iconThis preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: [ FORM 13 —Use the top of this page for your letterhead.] Consent to Treatment I acknowledge that I have received, have read (or have had read to me), and understand the “Information for Clients” brochure and/or other information about the therapy I am considering. I have had all my questions answered fully. I do hereby seek and consent to take part in the treatment by the therapist named below. I understand that devel- oping a treatment plan with this therapist and regularly reviewing our work toward meeting the treatment goals are in my best interest. I agree to play an active role in this process. I understand that no promises have been made to me as to the results of treatment or of any procedures provided by this therapist. I am aware that I may stop my treatment with this therapist at any time. The only thing I will still be responsible for is paying for the services I have already received. I understand that I may lose other services or may have to deal with other problems if I stop treatment. (For example, if my treatment has been court-ordered, I will have to answer to theother problems if I stop treatment....
View Full Document

{[ snackBarMessage ]}

Ask a homework question - tutors are online