Financially Responsible Party
I hereby authorize treatment by Paul Olander, MSW, JD, LCSW, NBCCH, CCTP, RRT-P, TIH. I understand that I am financially responsible for all services regardless of insurance benefits. I authorize Paul Olander, MSW, JD, LCSW, NBCCH, RRT-P, TIH to release information to process and secure payment for services. Full fees will be charged for appointments not cancelled 24 hours in advance (48 hours for weekend appointments).