Consent to Treatment Form
Graceland Psychiatry strives to treat Clients with consideration, respect and full recognition of their human dignity and individuality. Additionally, the Program does not discriminate in the provision of services based on race, creed, color, age, gender, sexual orientation, national origin, marital status, disabilities, and other classification prohibited under State and Federal law including The American with Disabilities Act, 28 CFR 35, and The Fair Housing Act, 42 USC 3604.
By initialing and signing below, I, the undersigned, do hereby state that I:
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