Client Consent and Personal Information Section - ashline 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering today’s date in the designated field. This helps track when the consent was obtained.
3. Select the type of setting from the options provided, such as Physician Office or Health Clinic, by checking the appropriate box.
4. Fill in your fax back number and address details, including city and zip code, ensuring all information is accurate for communication purposes.
5. In the Client Consent section, read through the statement carefully. If you agree, check the box indicating your understanding and provide your name and date of birth.
6. Sign in the Client or Guardian Signature field. If verbal consent was received, ensure to note that as well.
7. Indicate your county of residence and any comments if necessary. Lastly, select your preferred language and best time to call.

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