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Consent to Services

Please read and sign the form below.

Consent to Services


voluntarily request services for individual and family or other related concerns from House of Hope Programs. I/We have read and had the opportunity to discuss the Handbook and other program documents and request services/counseling in accordance with these guidelines.

I attest that I am the legal custodian of the above-named child and am authorized to seek services/treatment on their behalf.

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