Substance Abuse Treatment Consent Form
Client Name
Date of Birth
Treatment Consent
I hereby consent to participate in substance abuse treatment and related services as recommended and provided by the treatment facility and its staff. I understand the nature, objectives, benefits, and potential risks of this treatment:
Confidentiality
I understand that my records will be kept confidential as required by law, except in circumstances where disclosure is required:
Voluntary Participation
I acknowledge that my participation in treatment is voluntary, and that I may withdraw consent at any time:
Other Information (if any):
Client Signature
Date:
Staff/Witness Signature
Date: