Consent for Treatment

I authorize River Rock Treatment to evaluate, treat, and perform all clinical services including but not limited to individual therapy, group therapy, coaching, family therapy, holistic therapies, and adjunctive therapies deemed necessary in the evaluation and treatment of substance use and co-occurring mental health disorders.
River Rock Treatment does not discriminate on the basis of race, sex, creed, color, sexual orientation, or national origin when admitting clients to its programs. River Rock Treatment provides an outpatient and/or intensive outpatient level of care (between 1-25 hours of service per week). Clients who require medical services, detoxification, psychiatric or inpatient treatment may be referred to another agency. I understand that if admitted to River Rock Treatment, I will be offered ongoing resources to ensure my recovery post-discharge.

River Rock Treatment believes that to provide the highest level of care possible, assessment and evaluation (initial and ongoing) is vital to my successful treatment episode. As services are customized to each client, the assessment and evaluation process must be completed prior to treatment services being offered. I understand that there will be ongoing evaluation during my treatment episode to maintain the most comprehensive understanding of my needs during treatment.

Treatment planning and treatment recommendations are based off a person-centered, collaborative process between client and treatment team. River Rock Treatment believes in an empowering and motivational approach, always taking into consideration what I want out of treatment. I understand that River Rock Treatment may make suggestions based off assessment, evaluation, behavior, and other factors, but will always strive to work together with me in order to create the most effective treatment planning process possible.

By signing this Consent, I am agreeing to accept the care provided by River Rock Treatment. I have the right at any time to rescind this consent and discontinue my treatment. I have the freedom to choose what I would like to address as my goals in treatment and to refuse suggestions and/or treatments as I see fit. I also understand that continued refusal to participate in treatment, recommendations, or clinical indicated services may lead to clinical intervention and potential discharge from the program.

Therapeutic services involve interventions at emotional, mental, and social levels. Even in successful interventions, I may experience unsettling interruptions in normal patterns, feelings, and social relationships. I understand the risk of these interventions. I understand that I have the right to meet with my therapist or any member of my treatment team individually to discuss uncomfortable feelings and alter my person-centered plan as necessary.


I understand that abstinence from alcohol and drugs is a requirement of the program and agree to submit to any requests for urinalysis. I understand that failure to submit to urinalysis or positive testing may result in my discharge from the program. I have been advised and made aware that urinalysis or positive testing will be at my expense and that I further have the right also at my own expense to have any urine screen re-tested. I understand that this procedure and the results are confidential and covered under Federal laws of confidentiality.

I have been advised that as a client of River Rock Treatment, I am protected under Federal laws of confidentiality, which means that the program may not disclose any information without my written consent. I further understand that is required to disclose to state authorities any information if the following conditions exists: Information about a crime committed by me or another client of the program or against any staff member. Threats to commit a crime or an act of violence. Information concerning actual or suspected, child or elder, abuse or neglect. I understand that my records are protected under Federal Confidentiality Regulations (42 U.S.C 290dd-3 and 42 U.S.C. 290ee-3 for Federal Laws and 42 CFR Part 2 for Federal Regulations) published August 10, 1997; and cannot be disclosed without written consent unless other provided in the regulations. I understand that my medical records may contain information concerning my psychiatric, psychological, drug or alcohol abuse, HIV/AIDS and or related conditions. In the case of severe medical emergency, I have listed my emergency notification person on the Client Intake Sheet and do authorize River Rock Treatment to contact the party.
I understand that River Rock Treatment staff work as a team in order to provide the highest quality services to me. This means that my treatment team will consist of a variety of professionals, multi-disciplinary in nature, that will be discussed, sharing information, strategizing, and working together so I may have a successful treatment episode. I understand information shared with one staff member will not be confidential from the rest of the treatment team members.
Skip to content