AGREEMENT FOR SERVICE / INFORMED CONSENTFebruary 14th, 2015
FiledFebruary 14th, 2015This Agreement is intended to provide [name of patient] _ (herein “Patient”) with important information regarding the practices, policies and procedures of Jetta S. Zellner, LMFT (herein “Therapist”), and to clarify the terms of the professional therapeutic relationship between Therapist and Patient. Any questions or concerns regarding the contents of this Agreement should be discussed with Therapist prior to signing it.