Consent Form

  • Please type your Full Name to indicate you have read and understand this statement.
  • Please type your Full Name to indicate you have read and understand this statement.
  • Please type your Full Name to indicate you have read and understand this statement.
  • Please type your Full Name to indicate you have read and understand this statement.
  • Please type your Full Name to indicate you have read and understand this statement.
  • Please type your Full Name to indicate you have read and understand this statement.
  • Please type your Full Name to indicate you have read and understand this statement.
  • Date Format: MM slash DD slash YYYY
    I HAVE READ THIS AGREEMENT IN ITS ENTIRETY AND AGREE TO ENTER IN TO THERAPY AT HOUSTON RELATIONSHIP THERAPY ON THIS DATE:
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