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Informed consent agreement 


Welcome to Change, Inc.!

This legally binding document provides information about counseling and psychotherapy services you are about to receive. Please review carefully, and feel free to ask any questions. You are encouraged to return to this form at any time during your treatment process with us to re-familiarize yourself with our policies. If you've already filled it out once, there is no need to fill it out a second time.


Read each statement, and check the box next to it to "agree" with it.
Type full name.
Your Email(Required)
Address entered will receive a signed copy of this Informed Consent Agreement.
MM slash DD slash YYYY