Please Note that children over the age of 14 MUST also sign this Authorization
I do hereby give my consent for diagnostic, psychotherapeutic assessments, and treatment processes.
By checking the "Agree" box, and/or through signing, I ackowledge that I have read and understood all of the above.
By checking the "Agree" box, and/or through entering a full name, I ackowledge that I have read and understood all of the above.