CONSENT FOR TREATMENT

I voluntarily agree to receive a mental health and medical health assessment, substance use disorder treatment, co-occurring disorders treatment, and discharge/aftercare planning by the staff of PathLight Counseling to take place primarily on the grounds of the facility located at 4390 Earney Rd, Suite 140, Woodstock, GA 30188.

I understand and agree that I will participate in my treatment plan, and that I may discontinue treatment and/or withdraw my consent for treatment at any time.

I have read this Notice on the date indicated below.

August 11, 2022

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Signature Certificate
Document name: CONSENT FOR TREATMENT
lock iconUnique Document ID: 4ed6fa3899d6cc80fc83534c25dba034e91af061
Timestamp Audit
July 27, 2022 5:10 pm -02CONSENT FOR TREATMENT Uploaded by Britt Parramore - support@allydrez.com IP 162.239.100.54