Aimee Informed consent

Please REVIEW the below document prior to continuing.

COVID-19 Liability Waiver
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I agree to ALL of the above COVID-19 Liability Waiver statements (please initial)
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INFORMED CONSENT
Initial to accept ALL above conditions of this Informed Consent (Primary client)
Initial to accept ALL above conditions of this Informed Consent (Secondary client)
Signature of Primary Client

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CREDIT CARD AUTHORIZATION FORM
Card Holder's Name (as it appears on credit card)
Street Address
Apt/Suite
City
State
Zip Code
Credit Card Type

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Credit Card number
Exp. Date
CCV Code
Email
example@example.com
Cardholder's Signature

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CONSENT FORCOUNSELING SESSIONS via Doxy.me
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Printed Client Name
To complete your submission, please attach a VALID government issued photo ID. (Driver's license or Passport) *

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