910-289-2610

Informed Consent

INFORMED CONSENTS FOR TREATMENT AND SERVICES

If applicable, please initial next to each bolded item to confirm that you have received explanation and agree to the statement)

CONSENT FOR TREATMENT
NOTIFICATION OF CONSUMER RIGHTS
NOTIFICATION OF CONFIDENTIALITY
HIPAA
INTERVENTIONS
MISSED APPOINTMENTS
VOICE MESSAGES
FIRST AID
EMERGENCY CARE
FEE SCHEDULE
REFERRAL INFORMATION
AMENDMENTS

ACCEPTANCE: I (we) have read and/or have been clearly explained the terms, conditions, and agreements of the INFORMED CONSENTS FOR TREATMENT AND SERVICES agreement and voluntarily signed and accept them, as stated above. This agreement may be withdrawn, at any time, and will not exceed one (1) year after the date it has been signed.

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Informed Consent Form

NDG has received CARF (Commission on Accredited Rehabilitation Facilities) Accreditation since 2009. CARF standards are rigorous, so those services that meet the standards are often considered among the best available.

QUICK LINKS

CONTACT US

Two Convenient Locations

416 West Ridge Street Rose Hill, NC 28458

210 N. Sycamore Street Rose Hill, NC 28458

PHONE / FAX / MAIL

Phone: 910-289-2610

Fax: 910-289-4410

Mailing Address

PO Box 880 Rose Hill, NC 28458

© 2025 New Dimension Group

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