Patient/Client Rights

11 West 33rd St., Erie, PA 16508

Please print page and mail the filled out form to the above address.

This statement is intended to highlight your rights, help you remain in control, and remind you that you are the major partner in your emotional health care.

If you have any questions or concerns about any of this information, please feel free to discuss them with your therapist.

By signing below you are stating that you have read and understand this information.

Name:_____________________________ Date:____________