I agree I have received and read this Consent for Treatment outlining my responsibilities as a participant in treatment and have had any questions answered to my satisfaction. By my signature below, I verify that I understand the Disclosure Statement and my responsibilities as a client and consent to participate, or have my child participate, in treatment with Good Mental Health, LLC. If attending Couples Therapy, I understand that my/spouse’s signature(s) indicate that I/we give consent to release to my spouse any and all information discussed in session with my spouse present. I consent to the disclosure of necessary information to my insurance company for billing purposes if applicable. *