White Crane Clinic Client Responsibilities. 1. Each client and guardian is
responsible for providing accurate and complete information about current
complaints ...
White Crane Clinic Client Responsibilities 1. Each client and guardian is responsible for providing accurate and complete information about current complaints, past illnesses, hospitalizations, medications, con-current care, and other matters relating to her/his health. 2. Each client is responsible for reporting changes in her/his condition to a staff member. 3. Each client is responsible for making it known if she/he does not clearly understand treatment and what is expected of her/him. 4. Each client is responsible for assisting in the development of her/his treatment. 5. Each client is responsible for following the protocols and regulations of the White Crane Clinic. 6. Each client is responsible for making suggestions which she/he feels might improve the course of her/his treatment. 7. Each client is responsible for being respectful of the property of the White Crane Clinic. 8. Each client is responsible for meeting her/his financial obligations to the White Crane Clinic. 9. Each client is responsible for attending all scheduled appointments. 10. Each client is responsible for notifying staff with 24 hour advance notice if she/he will be unable to keep a scheduled appointment. 11. Each client is responsible for the fees for any missed appointment. My signature below acknowledges that I have read, understood, and agree to adhere to these client responsibilities. I have received a copy of these responsibilities as part of my new patient folder. _____________________________________________________________________________________ Client Signature Date _____________________________________________________________________________________ Guardian Signature Date _____________________________________________________________________________________ Witness Signature Date
