Form B SharedCustodyWITH legaldocs TREATMENT ThursMay16

      FORM B

 

 CONSENT TO CROSSROADS TREATMENT SERVICES

SHARED CUSTODY (DECISION MAKING)

PARENT/GUARDIAN’S CONSENT 

 

I, the undersigned                                                   ____________, declare that I have legal

(parent or guardian)

 

shared custody  (decision making) of   _____________________________________________and accept that they

(child’s name and date of birth)

 

participate in treatment services at Crossroads Children’s Mental Health Centre. I commit to informing the other parent of any clinical interventions and to sending them Form C in order to have them complete it and return it to Crossroads Children’s Mental Health Centre.

 

I have been advised that I have the right to withdraw my consent at any time.

_____________________________________________      ___________________________________

(Parent/Guardian’s signature)                               Date

 

 

 

 

 

 

 

 

 

Child & Family Clinic Hours

BY APPOINTMENT ONLY.

Let us know if you would prefer an in-person,  phone, or virtual session when booking your appointment.

WEDNESDAY 9am – noon  and

THURSDAY  Noon-8pm 

 

Back to top