Client Consent Form Package

CLIENT CONSENT FORM PACKAGE

This Client Consent Form Package ("Agreement") is entered into as of by and between Client Name: and Service Provider Name: .

RECITALS

WHEREAS, the Service Provider is duly qualified and experienced to perform the professional services described in this Agreement and is willing to provide those services to the Client in accordance with the terms set forth below;

WHEREAS, the Client seeks to engage the Service Provider to perform the services described herein and consents to the collection, use, and limited disclosure of certain personal information as necessary for provision of such services;

NOW, THEREFORE, in consideration of the mutual covenants and promises contained herein, the parties agree as follows.

SCOPE OF WORK

CONSENT AND AUTHORIZATIONS

The Client hereby provides the following consents and authorizations that are necessary for the Service Provider to perform the Scope of Work.

I authorize the Service Provider to perform the services described in the Scope of Work and acknowledge that I understand the nature and purpose of those services.

I consent to audio and/or video recording of sessions where required for service delivery, training, or quality assurance, subject to the Confidentiality provisions below.

I consent to the collection, processing, and storage of my personal information by the Service Provider for the purpose of providing services, billing, and maintaining records, in accordance with applicable law.

I authorize the limited release of information to third parties only where necessary to perform the services or as required by law (e.g., emergency services, court order).

PAYMENT TERMS

All fees are due as provided in the Payment Schedule. In the event of late payment, the Service Provider may assess the Late Payment Penalty specified above, suspend services after seven (7) days' written notice, and recover costs of collection, including reasonable attorneys' fees. Client remains responsible for services performed through termination.

TERM AND TERMINATION

Term Start Date:    Term End Date:

Either party may terminate this Agreement without cause by providing written notice to the other party in accordance with the Notice Period specified above. Either party may terminate immediately for cause if the other party materially breaches this Agreement and fails to cure the breach within fourteen (14) days after written notice. Termination does not relieve the Client of liability for unpaid fees or obligations that accrued prior to termination. Provisions that by their nature survive termination will remain in effect.

CONFIDENTIALITY

The parties acknowledge that, in the course of performance, each may receive confidential and proprietary information of the other. Each party agrees to maintain the confidentiality of such information, not to disclose it to third parties except as required for performance of this Agreement or by law, and to use at least the same degree of care as it uses to protect its own confidential information, but no less than a reasonable standard of care. Confidential information does not include information that is or becomes public through no fault of the receiving party, or that is independently developed or lawfully obtained from a third party.

GOVERNING LAW

This Agreement will be governed by and construed in accordance with the laws of the jurisdiction specified below. The parties submit to the exclusive jurisdiction of the courts located therein for disputes arising under this Agreement.

ENTIRE AGREEMENT

This Agreement, including all exhibits and attachments signed by the parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written. No amendment or modification will be effective unless in writing and signed by both parties.

CLIENT INFORMATION & ACKNOWLEDGEMENTS

CERTIFICATION

By signing below, the Client certifies that all information provided in this Agreement is true and complete to the best of the Client's knowledge, that the Client has read and understands the terms set forth herein, and that the Client consents to the procedures and authorizations described above. The Service Provider certifies that it will perform services in a professional manner consistent with industry standards and applicable law.

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