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Roots Treatment Plan Acknowledgement - Staff Requested

Treatment Plan Participation Acknowledgement

Client Name: 
Date of Birth: 
Primary Counselor:

By signing this form, I acknowledge that I have participated in the development and revision of my individualized treatment plan and agree with the contents of the plan.

I also acknowledge that any items marked “Must be reached to have services terminated” must be completed before I am able to complete the primary phase of the treatment program with a “successful completion” designation.

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Your legal name

Your email address

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July 20, 2020 2:32 pm CDT

Roots Treatment Plan Acknowledgement - Staff Requested Uploaded by Roots Recovery - rootsforms@mncarepartner.com IP 206.84.190.44

July 20, 2020 3:26 pm CDT

Roots Forms - rootsforms@mncarepartner.com added by Roots Recovery - rootsforms@mncarepartner.com as a CC'd Recipient Ip: 174.53.135.153

July 20, 2020 3:27 pm CDT

Roots Forms - rootsforms@mncarepartner.com added by Roots Recovery - rootsforms@mncarepartner.com as a CC'd Recipient Ip: 174.53.135.153

July 21, 2020 1:51 pm CDT

Roots Forms - rootsforms@mncarepartner.com added by Roots Recovery - rootsforms@mncarepartner.com as a CC'd Recipient Ip: 174.53.135.153