Annual Treatment Renewal Consents
Informed Consent to Receive TreatmentPlease Read and Sign
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Treatment Plan ConsentPlease discuss with your provider and sign.
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Authorization to Release InformationPlease read and sign for Authorization to Release Information with Primary Care Physician and Insurance Company. Information is not released without your knowledge and only what is necessary for providing comprehensive quality healthcare or for billing purposes.
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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).
| _sc_annual_consents_22.doc |
