Consent to Treat

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  • I understand that the treatment offered by CenterPoint Counseling and Consulting is of a voluntary nature. I hereby consent to the diagnostic and treatment procedures suggested by the licensed clinician, given the symptoms I have shared. I do so with the understanding that I have the right to accept or reject any and/or all treatment plans that are presented to me.
  • Signature of Consent: My/our signatures below indicate our Consent To Treat.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
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