I am the parent of said child. As such, I have decision-making authority for medical decisions for this individual, and hereby give consent for 3:16 Parenting PC and its licensed professionals to provide counseling for this individual.
I understand that the services I receive at 3:16 Parenting are for treatment only, and that it is outside the scope of this treatment to make any suggestions or determination about custody arrangements or parental fitness.
I understand that my therapist will not keep secrets between me and other members of my family. I further understand that it could be detrimental to the treatment of my child if his or her therapist were to be required to appear in court.
I will provide a copy of the parental agreement/custody papers by the next appointment or downloaded below.