Informed Consent for GROUP Counseling Agreement - elizabethhospice 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by reviewing the 'Fees for Services and Payment of Fees' section. Indicate your fee choice by checking the appropriate box and entering the amount for the specialized support group.
3. In the 'Group Counselors' section, familiarize yourself with your counselor's qualifications. This ensures you understand who will be guiding you through the counseling process.
4. Read through the 'Confidentiality' section carefully. Acknowledge your understanding of confidentiality rules by ensuring you are aware of circumstances under which confidentiality may be broken.
5. Proceed to sign and date the form where indicated. Make sure to print your name clearly in the designated fields, whether for yourself or on behalf of a minor child.
6. Lastly, provide an emergency contact's name and phone number in the specified area to complete your form.

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