300 Old Pond Rd # 201
Bridgeville, PA 15017
Therapy Treatment Plan Sign-off
For Office Use Only:
My signature indicates that I have participated fully in the development and review of my individual treatment plan and agree with the plan. Under penalty of perjury, I herewith affirm that my electronic signature, and all future electronic signatures, were signed by myself with full knowledge and consent and am legally bound to these terms and conditions.