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I accept financial responsibility for payment of services received, and for payment of late cancellation fees. If I use insurance to pay all or a portion of the charges, I hereby authorize the release of information necessary to process insurance claims filed on my behalf. I acknowledge that I am financial and legally responsible for the full payment of charges for services received in the event my health insurance policy does not cover my claim. I am 18 years of age or older or I have legal custody of this minor child(\u2587\u2587\u2587). 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Cell phone number to send text messages to: ( ) - Automated Voice Messages: I authorize Care and Counseling to send computer generated voice phone message appointment reminders to me on my provided phone number.", "hash": "ea5947290cb0b1f97285bd03e6035b9f", "id": 4}, {"samples": [{"hash": "ldZcjIpFcEl", "uri": "/contracts/ldZcjIpFcEl#client-consent", "label": "Workforce Development Agreement", "score": 20.9479808807, "published": true}, {"hash": "4ER4yCNGipZ", "uri": "/contracts/4ER4yCNGipZ#client-consent", "label": "Workforce Development Agreement", "score": 20.767282486, "published": true}], "snippet_links": [{"key": "personal-information", "type": "clause", "offset": [76, 96]}], "size": 2, "snippet": "How am I supposed to explain to clients why I am asking them to share their personal information with me?", "hash": "4db427883a45fb1536a0ad5fe48c037a", "id": 6}, {"samples": [{"hash": "fFj4DvBWxs7", "uri": "/contracts/fFj4DvBWxs7#client-consent", "label": "Client Agreement", "score": 23.1916503906, "published": true}, {"hash": "6bHGlW7L2Vo", "uri": "/contracts/6bHGlW7L2Vo#client-consent", "label": "Client Agreement", "score": 21.8268318176, "published": true}], "snippet_links": [], "size": 2, "snippet": "Declaration", "hash": "6246655a4c0a99b49f104cd87a0a7a7a", "id": 7}, {"samples": [{"hash": "cm7ogCqGzyz", "uri": "/contracts/cm7ogCqGzyz#client-consent", "label": "Merger Agreement (Wilmington Trust Corp)", "score": 18.0, "published": true}, {"hash": "1VYmqHQerF1", "uri": "/contracts/1VYmqHQerF1#client-consent", "label": "Merger Agreement (Wilmington Trust Corp)", "score": 18.0, "published": true}], "snippet_links": [{"key": "section-62", "type": "clause", "offset": [3, 14]}, {"key": "conduct-of-business", "type": "clause", "offset": [15, 34]}, {"key": "section-63", "type": "clause", "offset": [102, 113]}, {"key": "preservation-of-business-and-assets", "type": "clause", "offset": [114, 149]}, {"key": "section-64", "type": "clause", "offset": [201, 212]}, {"key": "section-65", "type": "clause", "offset": [300, 311]}], "size": 2, "snippet": "27 Section 6.2 Conduct of Business................................................................ 27 Section 6.3 Preservation of Business and Assets................................................ 28 Section 6.4 Standstill......................................................................... 29 Section 6.5", "hash": "f75eef2ee16d437c7884e6ab9b2f6963", "id": 8}, {"samples": [{"hash": "fLVVjbQfwNC", "uri": "/contracts/fLVVjbQfwNC#client-consent", "label": "Psychotherapy Agreement", "score": 28.5397262573, "published": true}, {"hash": "4uanhJFA2hp", "uri": "/contracts/4uanhJFA2hp#client-consent", "label": "Psychotherapy Information and Agreement for Psychological Services", "score": 23.2491436005, "published": true}], "snippet_links": [{"key": "prior-to", "type": "definition", "offset": [83, 91]}, {"key": "your-signature-below", "type": "definition", "offset": [111, 131]}, {"key": "agree-to", "type": "clause", "offset": [178, 186]}, {"key": "responsibility-for-payment-of-fees", "type": "clause", "offset": [213, 247]}, {"key": "in-accordance-with", "type": "definition", "offset": [248, 266]}, {"key": "these-terms-and-conditions", "type": "clause", "offset": [267, 293]}], "size": 2, "snippet": "If you have questions about anything you've read here, please discuss them with me prior to signing this form. 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