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Mental Health History

Medical History

Reason for visit

Consent For Treatment

I, the undersigned am giving consent to treatment as determined by my provider at Liquid Sunshine Mental Health. A) I understand that an initial evaluation is required to determine the proper course of treatment.

Practice Guidelines

Welcome to Liquid Sunshine Psychiatric Services where our objective is to provide evidenced based treatment for treatment of mental illnesses. The treatment may consist of psychotherapy and medications.

Notice of Receipt of Practice Guidelines

I have received a copy of practice guidelines of Liquid Sunshine Mental Health Services. If I have any questions or concerns it is my responsibility to ask for clarification. I can ask for clarification at any time during my course of treatment.

Notice of Privacy Practices Liquid Sunshine Mental Health Services

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Notice of Privacy Practices- Receipt

A record is kept of your treatment at Liquid Sunshine Mental Health Services. You may ask to see this record. We will not disclose this record unless you give permission, or in the event of an emergency as outlined in our privacy practices. Your signature