I, as a consumer of New Horizons of the Treasure Coast, Inc. or the parent/guardian/guardian advocate of the subject of this consent, hereby give consent to the professional staff of New Horizons to administer treatment.

Treatment/Services may include crisis stabilization, residential, individual, group, or family therapy, psychiatric services, case management, community support, and ongoing needs assessment. The purpose of treatment/services is to facilitate the recovery process.

I understand that Treatment/Services may be provided via Telehealth or Telepsychiatry, and American Sign Language (ASL) Services via Video Remote Interpretation are available and may be needed for effective communication.

I will be informed of the nature and purpose of treatment, its common side effects, alternative treatment modalities, and the approximate length of care. I will also be informed that consent can be revoked orally or in writing before or during the treatment period.

Psychotropic meds may be offered; however, medications will be discussed on a case-by-case basis and will require additional consent from the patient, parent, or guardian. New Horizons does not offer electroconvulsive treatment or any surgical treatment requiring the use of an anesthetic at this time.

In addition, I understand that New Horizons may need to report my data to any of their funders for statistical reporting and Quality Assurance.

I have read and fully understand the above Consent for Treatment. No guarantee or assurance has been given regarding the results that may be obtained from the treatment/services I receive at New Horizons.