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Custody Declaration Form

As Roamers Therapy, our responsibility and goal is the well-being of our clients. In the case of a child as the primary client, it is essential that parents and/or legal guardians are in an agreement as to the decision to treat, the treatment goals, appointment times and the need to maintain client confidentiality. As a result, it is the policy of Roamers Therapy that all minors presented for treatment have the following authorization and consent on file.

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Name of the Minor
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