Consent to Treatment by Practicum Student


InMindOut Emotional Wellness Center, LLC is committed to the education and training of future clinicians in mental health. As such, we employ Practicum Students on our staff. A Practicum Student is an individual who is pursuing their doctoral degree in clinical/counseling psychology. The Practicum Student is under the supervision of Dr. Heather Ingram, while engaging with clients at InMindOut, LLC.

  • I understand that all terms from the InMindOut Emotional Wellness Center, LLC Psychologist – Client Contract apply to sessions with Practicum Student.
  • I am willing to receive therapeutic services from the Practicum Student.
  • I understand that I can terminate this agreement at anytime.

 

 

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InMindOut Emotional Wellness Center https://inmindout.com
Signature Certificate
Document name: Consent to Treatment by Practicum Student
Unique Document ID: 7f2944a0dd472effa23636031b1e20812e35eda1
Timestamp Audit
October 21, 2017 2:16 pm CSTConsent to Treatment by Practicum Student Uploaded by Amanda Bergeron Bergeron - amanda.bergeron@inmindout.com IP 23.122.45.227
January 15, 2018 11:37 am CST Document owner amanda.bergeron@inmindout.com has handed over this document to imo@inmindout.com 2018-01-15 11:37:38 - 23.122.45.227