Consent for Services, Emergency, & Transportation
I apply for and consent to such medical, psychiatric and / or other service as the staff of CLAYS may indicate, including diagnostic tests and counseling. I agree to co-operate in the implementation of the services. I have been informed that statistical information concerning my treatment will be submitted to Department of Health & Human Services. I understand and agree that in some emergency situations the agency may have to disclose some information in order to assist with a crisis or emergency incident. I also agree that the agency will not be held to any litigation if I accept transportation from an agency worker.