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Youth Consent Waiver

All persons under the age of 18 are required to have a parent or guardian fill out this form. By signing, you  agree that you are the parent or legal guardian of the minor receiving treatment(s) at our facility. You understand that you may be required to remain at the facility for the entirety of the minor’s treatment(s). You will also be required, if needed, to assist the minor in preparing for his/her treatment(s) by discussing course of treatment with both minor and therapist. You also agree that you have completed the Intake Form and have informed the therapist of all medical diagnoses, symptoms, medications, and complaints associated with the minor receiving treatment(s).

*I certify that I have completed the Intake Form for the above-mentioned minor and informed the therapist of all relevant medical history and concerns. I understand the scope of work being provided and that is not meant to diagnose, treat, or cure any condition and is not a replacement for standard medical care. I give permission for my minor child to receive treatment(s) at this facility and agree to all the above terms.

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