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Declaration and Client Consent Form - Hawthorn Clinic 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering your name in the designated field at the top of the form. This personalizes your consent.
- In section 1, list the treatments you consent to receive from Dr. Susan Ritcey. Ensure each treatment is clearly specified.
- Review section 2 carefully, which outlines what has been explained to you regarding the treatments. Confirm your understanding of each point.
- In section 3, provide details about any medications or health conditions you currently have. This information is crucial for your safety.
- Section 4 confirms your ability to seek additional medical care if needed. Acknowledge this by checking the box provided.
- Read through sections 5 to 9, ensuring you understand all statements regarding confidentiality, fees, and consent for communication.
- Finally, sign and date the form at the bottom. If applicable, have a parent/guardian or witness sign as well.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2014 | 4.8 Satisfied (92 Votes) |
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