Printable Agreement
Consultation Agreement
Consultation Date: ______/_____/______
Legal Name: ________________________________
Address: ___________________________________________
City: ___________________________________________
State: ___________________________________________
Zip: ___________________________________________
Phone: ___________________________________________
Email: ___________________________________________
In signing this, I understand that I and only I, am responsible for any and all information. I also do not hold my consultant responsible for anything concerning this consultation. I further agree that all modalities consultations offered are not a replacement or substitute for medical or psychological treatments.
Signature: _______________________________________
Date: _____/_____/_______