Forms - Pelican Therapy Partners

General Agreement

HIPAA Policy

HIPAA Receipt

Release

Risk Assumption

Attendance

Child Intake

Credit Authorization

General Acknowledgement of Forms

Client Name

Phone Number

I hereby acknowledge and agree that I had read all of the forms and documents provided to me in connection with evaluation and treatment provided by Pelican Therapy Partners and/or their employees and contractors.

I understand the meaning and intent of the provided forms and agree to all content included.

I have been given an opportunity to ask questions about the provided forms and all questions I’ve asked have been answered to my satisfaction by Pelican Therapy Partners

Parent/Guardian Signature

Clear

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