Intake Forms Acknowledgement - eSignature
Client Date of Birth:
Person Signing this form is: Client Parent/Guardian
Name of Person Signing this Form:
I attest that I have reviewed and understand the forms in this document, as listed below:
I agree to the information contained in each form to which I have attached my initial, attestation, or signature.
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Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: Intake Forms Acknowledgement - eSignature
Agree & Sign