My signature below indicates that I have received the following written information from Northwestern Mental Health Center, Inc. and that the documents have been discussed with me by staff.
ATTENTION: This is a legal document. Please read carefully.
By signing, you agree that you understand and accept the terms in this form.
If the client is 18 years of age or older, the client must sign and date the form.
If the client is 18 years of age or older and is incapable of signing, a legally authorized substitute may sign and date the form.
If the client is 17 years of age or younger, the client’s parent or legal guardian must sign and date the form, unless an exception exists under state or federal law.