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Counseling- SB

Consent for treatment of minor

Consent for treatment of a minor

To be completed by a parent/guardian for students seeking services under age of 18

I understand that maintaining confidentiality in a course of counseling is essential to building a trusting relationship and that staff will share information only when necessary. Furthermore, in the event that time will not allow me to be reached, or that I cannot be reached, I hereby give permission for the Counseling Center staff to secure necessary consultative care for my child, to include hospitalization, and other indicated treatment as deemed necessary.
Please include country/area code

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