BRIGHT FUTURE COMMUNITY HEALTH CARE SERVICES

CONSENT OF PARTICIPATION

Phone: (443) 832-4526 Fax: 1 (877) 288-4626Email: brightfuturehealthcareservices@gmail.com
Client Name *

First Name Last Name
I, , agree to participate in

Mental Health Services (Individual, Group and Family Therapy) provided by BFCHCS and will participate in the development of the Individual Treatment Plan for Mental Health services. I hereby give consent for services to be provided. I have been informed and received copies of the Client Rights and Responsibilities and Discharge and Grievance Procedures by Bright Future Community Health Care Services.
Client/Guardian Signature *

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Date *

Month Day Year
Staff Signature *

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Staff Name *

First Name Last Name
Date *

Month Day Year
Phone: (443) 832-4526 Fax: 1 (877) 288-4626 Email: brightfuturehealthcareservices@gmail.com
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CONSENT OF PARTICIPATION