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I give full consent for my child to attend Crossroads Therapy and Support Services for psychological treatment. I understand that my child is the client – not me, any other sibling, or my former spouse. This is true regardless of who pays for the evaluation/treatment of my child. I understand that it is my responsibility to provide information regarding custody arrangements and contact information of the other parent. I understand that Crossroads Therapy’s primary responsibility is to my child’s best interest and may decide to involve me in my child’s evaluation/treatment at their sole discretion. I understand that if payment is not received promptly for services rendered to my child, the services may be suspended or terminated. I understand that the therapist may contact the other parent of my child for informed consent for treatment or background information at any time during treatment. I understand that any professional at Crossroads Therapy and Support Services is not agreeing to be an expert witness or to testify on my behalf or on behalf of any other individual other than my child at any deposition, court proceeding, or in any other way. Should the therapist be subpoenaed, I understand that I am responsible for any costs associated with the subpoena. Crossroads Therapy may also charge for the receipt of any correspondence or acceptance of any telephone calls, other than those directly from the court for my child.

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