Informed Consent for Treatment

For your reference (you will be required to sign this through your client portal prior to commencing therapy):

I give consent for evaluation and treatment to be provided for myself/my child by either Erin Shobe, M.A., LMFT, RPT-S; Molly Samuelson, M.A., LMFT; Melissa Tyler, M.A., LMFT, LAMFT; Elliott Odendahl, MSW, LICSW; Carol Strand MA, LMFT, ATR; Spencer Corrigan, MA, LAMFT; Claire DeBennedetto, MS, LMFT; Stacy Swenson, MSW, LISCW; Julie McMonagle, MSW, LISCW; Deric Jackson MA, LICSW; John Burggraff, MS, LICSW, Diana Johnson; Madisyn Eckl; Natasha Isaman, MSN, APRN, PMHNP-BC, PMH-C

I am aware that the practice of psychotherapy is not an exact science and that results cannot be guaranteed. No promises have been made to me about the results of treatment.

Information on the risks, benefits, and alternatives of treatment have been made available to me through the Introduction to Therapy documents, and I have had the opportunity to ask questions.

I understand that I need to provide accurate information about myself/my child to my clinician so that I/my child will receive effective treatment. I also agree to play an active role in the treatment process.

I understand that I may terminate treatment at any time. My signature below shows that I understand and agree with all the above statements. If the client is a minor or has a legal guardian appointed by the court, the client’s parent or legal guardian must sign the consent.