PsychotherapyForWomen.com Vicki Bonnell, LCSW. vickibonnell2@gmail.comEMERGENCY PROTOCOLS
I understand that my therapist may need to contact my emergency contact and/or appropriate authorities in case of an emergency.
In case of an emergency I will need your location and a contact person whom I may contact on your behalf in a life threatening emergency only.
This person will only be contacted to go to your location or take you to the hospital in the event of an emergency.
I understand the information contained in this form and all of my questions have been answered to my satisfaction.
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Signature of Client/parent/legal guardian
___________________________________ Date: __/__/__
Signature of Therapist