Consent:

Drew’s Place Psychotherapy Services, Inc. and the included hosts of this webinar will not use personal information submitted to this form for any purpose other than the purpose of registration for this webinar or any requested contact made in the registration information.

I hereby grant permission via this form for Drew’s Place Psychotherapy Services, Inc.  to record the webinar and to use, adapt, modify, digitize, reproduce, broadcast, transmit, exhibit, post, and perform, in any form now existing or later developed, the webinar, including without limitations on the Drew’s Place website or media outlets, without restriction as to frequency or duration of usage.

I hereby acknowledge a volunteer client will be participating in this webinar and I commit to holding client information confidential as defined as Protected Health Information (“PHI”) in the Health Insurance Portability and Accountability Act of 1996 or its relevant regulations (HIPAA). 

Your registration and consent is not considered complete until you add your name below and click “Submit”. Payment will be ran on or before Friday the week upon receival of registration. An email receipt and link to the webinar will be provided through the email address provided on the registration form.