Treatment Plan Signature Page

Treatment Plan Signature Page
Effective Date of Treatment Plan

Month Day Year
Date
Client Name

First Name Last Name
By signing below, I acknowledge that I/we have participated in the development process of this treatment plan. I/we understand that changes can be made to this treatment plan at any time and when clinically indicated.
Client Signature/Legally Responsible Party/Guardian

Clear
Signature Date

Month Day Year
Date
Should be Empty: