Free Client Intake Consent Form Template
Client Intake Consent Form
Please complete this form to collect and use your information for service purposes.
Name
Phone Number
Email Address
Home Address
Consent & Agreement
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Collection & Use of Information: I consent to collecting and using my information for service-related purposes.
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Confidentiality & Privacy: I understand my information will be kept confidential and only used as necessary.
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Communication: I agree to be contacted by the company via phone, email, or other preferred methods.
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Liability & Responsibility: I acknowledge that I have provided accurate information and understand the risks associated with the services provided.
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Terms & Conditions: I have read and agree to the company's policies and procedures.
Name:
Date:
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