Financial Contract
YOUR SIGNATURE BELOW INDICATES THAT YOU HAVE READ THE INFORMATION IN THIS FINANCIAL/BILLING AGREEMENT AND AGREE TO ALL STIPULATIONS ABOVE AND TO PAY FOR ALL PROFESSIONAL SERVICES RENDERED BY SEASONS PSYCHOLOGICAL THERAPY, LLC IN ACCORADANCE WITH THIS AGREEMENT.

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Client Last Name *
Client First Name *
Date of Birth *
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Client Signature *
Date *
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Parent or Legal Guardian Signature
Date (Guardian)
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DD
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YYYY
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This form was created inside of Seasons Psychological Therapy.