I understand that a range of mental health professionals may provide services or treatment to me. All professionals-in-training are supervised by licensed staff during my assessment or treatment at CHCCW.
I understand that while psychotherapy and/or medication management, may provide significant benefits, it may also pose risks. Psychotherapy may elicit uncomfortable thoughts and feelings or may lead to the recall of troubling memories. Medications may have unwanted side effects. Medication management can be complex and may require continual monitoring to control or prevent unwanted side effects.
I understand that I am expected to make every attempt to pay any payment due, copayment, or coinsurance amount at the time of service, but understand that an inability to pay will never prevent me from being treated at CHCCW.
I understand that I, staff and other patients all have the right to a safe environment and that any abusive or threatening behavior will not be tolerated and will be cause for termination of services.
If I have any questions regarding this consent form or about the services offered at CHCCW, I may discuss them with my clinician. I have read and understand the above. I consent to participate in the evaluation and treatment offered to me by CHCCW. I understand that I may stop treatment at any time.