CONSENT TO TREATMENT AND PAYMENT AUTHORIZATION FORM
Prior to your first session, you will need to fill out the form below in which you agree to:
- The policies and procedures for treatment (link) at IPG
- Acknowledge how IPG preserves your privacy and confidentiality (link), and
- Authorizes payment through your Credit, Debit, or HSA/FSA benefits card
This form is only to be filled out once you have been assigned a therapist. Please select the email address of your therapist in the form below so that they will automatically receive notification that this form has been completed, and your treatment can begin.