By filling up this form, you consent to the use, processing, and storage of your personal data such as your name, age, contact details, and all necessary information gathered from the Intake and Informed Consent Form for the purpose of facilitating consultation services and record-keeping. Light Level Psychological Solutions Incorporated will not give or sell your personal data to any third party or use said data outside the purpose outlined in this clause.
I have read the information in this form. I understand the risks and benefits of online counseling/psychotherapy/ psychiatric consultation, the nature and limits of confidentiality, and what is expected of me as a client of Light Level Psychological Solutions Incorporated.
