Client Consent Clause Samples

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Client Consent. My signature below indicates that I reviewed this document, agree to the policies, and authorize the services. I accept financial responsibility for payment of services received, and for payment of late cancellations. If I use insurance to pay all or a portion of the charges, I hereby authorize the release of information necessary to process insurance claims filed on my behalf. I acknowledge that I am financial and legally responsible for the full payment of charges for services received in the event my health insurance policy does not cover my claim. I am 18 years of age or older or I have legal custody of this minor child(▇▇▇). ▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ • ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Client Consent. I/We understand and consent to the above terms and I hereby authorise the transfer of information, as described above on a confidential basis when warranted between such third parties. I/We agree that the Client Agreement will come into effect from the date of issue.
Client Consent. The Client hereby grants to the Department of Waste Management and its employees, the permission to enter upon and use the venue for the purpose of delivery and removal of litter bins.
Client Consent. This is our standard client agreement upon which we intend to rely. For your own benefit and protection you should read these terms carefully before signing them. If you do not understand any point, please ask for further information.
Client Consent. My signature below indicates that I reviewed this document, agree to the policies, and authorize the services. I accept financial responsibility for payment of services received, and for payment of late cancellation fees. If I use insurance to pay all or a portion of the charges, I hereby authorize the release of information necessary to process insurance claims filed on my behalf. I acknowledge that I am financial and legally responsible for the full payment of charges for services received in the event my health insurance policy does not cover my claim. I am 18 years of age or older or I have legal custody of this minor child(▇▇▇). Client Signature: Date: Custodial Parent or Guardian Signature: Date: Therapist Signature: Date: ▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ • ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ Care and Counseling offers the option to receive an appointment reminder the day prior to your scheduled appointment by email (up to 2 email addresses) and/or by phone (only 1 phone number permitted). If you choose the reminder by phone, you have the option of a text message or a computer-generated voice message. PHONE REMINDER (only one type of phone reminder can be provided): Text Message: I authorize Care and Counseling to send text message appointment reminders to me on my provided cell phone number. Text message charges from my cell phone provider may apply. Cell phone number to send text messages to: ( ) - Automated Voice Messages: I authorize Care and Counseling to send computer generated voice phone message appointment reminders to me on my provided phone number.
Client Consent. How am I supposed to explain to clients why I am asking them to share their personal information with me?
Client Consent. 27 Section 6.2 Conduct of Business................................................................ 27 Section 6.3 Preservation of Business and Assets................................................ 28 Section 6.4 Standstill......................................................................... 29 Section 6.5
Client Consent. If you have questions about anything you've read here, please discuss them with me prior to signing this form. Your signature below indicates that you have read, understand, and agree to these policies and accept responsibility for payment of fees in accordance with these terms and conditions.
Client Consent. Client hereby grants Babette’s and its employees, to enter the Property for the purpose of providing a design consultation.
Client Consent a. As soon as practicable after the date hereof, each of the ▇▇▇▇▇▇▇▇▇ Entities shall notify each of its clients (including the participants in each Existing Fund) of the transactions contemplated hereby and by the other Transaction Documents. That notice shall be in the form of Exhibit 6.1(a) hereto. b. As soon as practicable after the notice in Section 6.1(a), each of the ▇▇▇▇▇▇▇▇▇ Entities shall send to each client who has not returned the notice in substantially the form of Exhibit 6.1 (a) hereto, countersigned indicating approval of the transactions contemplated hereby, a second notice and consent in substantially the form of Exhibit 6.1 (a) hereto and acceptable to WTI, which acceptance will not be unreasonably withheld, delayed or conditioned.