Psychotherapy – Family Therapy – Group Therapy – Other Meds
Your signature below acknowledges that:
- The above medication(s) and treatment have been adequately discussed with you and should be taken only as prescribed.
- You have received all of the information you desire concerning such medication(s) and treatment.
- I have received Medication Information Sheet(s) and have had an opportunity to review with the prescriber the specific benefits and side effects of prescribed medicine(s).
I hereby give my consent to treatment with this medication. I understand that I may seek additional information, and that I may withdraw this consent at any time by stating my intention to any member of the treatment team.
