New Patient Services Agreement
Legal Guardian 2
This agreement is between you and Behavioral Health Clinic, LLC (BHC). We use the word "patient" to refer to you, your child, or another person for whom you serve as legal guardian and for whom these services are being rendered.
Consent to Treatment
I voluntarily agree to receive mental and behavioral health assessment, care, treatment, or other services and authorize BHC to provide such services as are considered necessary and advisable. Treatment relationships come with rights and responsibilities as described (please check each box to indicate you have read and that you acknowledge each statement; all boxes must be checked or BHC cannot provide you services):