My signature affixed below affirms that I have received, read, fully understand, and agree to the contents of each document listed above, and should I have any questions or are unable to view the electronic copy of these documents provided above, I will ask a staff member of Astra Behavioral Health, LLC for assistance.
Furthermore, my signature affixed below acknowledges I wish to have treatment given to me, my child, or my ward by Astra Behavioral Health, LLC. Also, my signature affirms I have been informed of the treatment and procedures necessary, which will be performed by a psychiatrist, psychiatric nurse practitioner, therapist, and/or assisted by other staff members of Astra Behavioral Health, LLC; and my authorization to receive such treatment and procedures is hereby granted.