Welcome to Think Well. We are committed to providing you with quality patient care. The following therapeutic treatment contract outlines your responsibilities in this process. Please take the time to read and sign the below agreement. If you have any questions, please let us know.

Attendance

Each appointment is a time we have reserved specifically for you. That is why we recommend that you make every effort to attend your scheduled appointments.

• Please notify the clinic at least 24 hours in advance if you cannot keep your appointment. We understand that emergencies occur; your provider will address these situations on an individual basis. Cancellations less than 24 hours in advance will be considered a late cancellation.

• Three missed appointments or late cancellations within a 12-month period could result in termination of your treatment.

• If you arrive late for your appointment by 10 minutes or more, we will not be able to meet with you and you will need to be rescheduled.

Conduct

All clients must conduct themselves in a courteous manner in the clinic.

• We reserve the right to terminate your treatment if you commit violence, are verbally/physically threatening to providers and/or staff or other clients, or conduct any illegal or disruptive activities in the clinic.

• WARNING: ASSAULTING A HEALTH CARE PROFESSIONAL WHO IS ENGAGED IN THE PERFORMANCE OF HIS OR HER OFFICIAL DUTIES, INCLUDING STRIKING A HEALTH CARE PROFESSIONAL WITH ANY BODILY FLUID, IS A SERIOUS CRIME WHICH MAY BE PUNISHABLE AS A FELONY.

• Misuse of any prescribed medications may result in termination of treatment. Please reference Think Well Controlled Substance Policy and Agreement.