I authorize my insurance company to pay directly to Northlight for services rendered for me, my children, ward or spouse. I authorize the release of any information pertinent to my case to any insurance company or adjustor involved in this case. A photocopy of this Assignment shall be considered as effective and valid as the original. This is a direct assignment of my rights and benefits under the policy. I also authorize Northlight Counseling Associates, Inc. to initiate a complaint to the Insurance Commissioner for any reason on my behalf. I understand that the filing of a claim to my insurance company is a courtesy to patients.