Consent for Service combined form

Agreement to Online Service

  1. I agree that this is an addendum to the Service Agreement previously provided by Dr. Lorri Yasenik. This Addendum is to be read in conjunction with the terms of the Service Agreement.
  2. I agree to abide by the terms of this addendum in order to create the most efficacious online therapeutic environment.
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Lorri Yasenik PhD RSW
(Registration number 1432)

Please click the submission button to send in your agreement.