SOCIAL MEDIA

Agency Consents

1.

Informed Consent to Receive Treatment

Please Read and Sign

2.

Authorization to Release Information to Designated Agency/Third Party

Please read and sign for Authorization to Release Information with the designated Agency.  Information is not released without your knowledge and only what is necessary for providing comprehensive quality healthcare or for billing purposes.

3.

Telehealth Consent

Please Read and Sign

4.

Treatment Plan Consent

Please discuss with your provider and sign after your Assessment Interview. 
You may also PRINT the Consents, below.  Please return the completed forms confidentially by Fax @ 888-972-4998,  by Email to [email protected] or drop them off at the office (Call before coming-980-613-8312). 
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