I, First Name* Last Name* understand I am voluntarily agreeing to participate with the organization The Open Table. I also understand that I cannot be compelled to accept services. This consent form must be reviewed and agreed to either verbally or in writing prior to the initiation of the Network Table process. If I choose not to consent, I will not receive services from The Open Table at this time. I also understand that I cannot be compelled to accept this invitation by Open Table. This does not limit me from participating in the future. I also understand that once I consent to services, I can revoke at any time. I have been informed about Open Table/Network Tables. It has been explained that this organization is staffed primarily with volunteers who make up “Tables” and those volunteers will be in contact with me to find solutions in the community that might be able to meet my identified need. I understand that my name, contact information and summary of my need will be shared with the volunteers on the Network Table. I understand that I will be a part of the process in finding a solution to my identified need (priority support) and am under no obligation to accept the solution. However, if I do not accept the solution, the Table will close my priority support and move on to the next referral. I understand that this is not a treatment program and Open Table does not market itself as a treatment model. Instead, Open Table provides training and support to members of the community to help find solutions that might help improve my well-being. In order that I might benefit from The Open Table model, I hereby provide consent to participate with a Network Table.