CONSENT TO TREAT

In order for a Revive clinician/counselor/coach to perform treatment and services, clients must acknowledge and accept Revive's terms of service. Please read each section and initial, then sign and date at the bottom of the form.

Note: If your are receiving counseling or coaching as a couple or family, each person needs to complete their own Consent to Treat form.

THE PROCESS

SESSIONS

FEES

CANCELLATION POLICY

CANCELLATION DUE TO WEATHER/NATURAL DISASTERS/GLOBAL FACTORS

INSURANCE

CONFIDENTIALITY

EMERGENCIES

SUPERVISION OF CHILDREN

LEGAL MATTERS

CUSTODY OF MINORS

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ACKNOWLEDGEMENTS