Client Agreement Form

 

 

As a client of Heart of Hannah, I agree to the following.

 

• I will make phone call only to my immediate family members only.

• I write and receive mail from my family members only.  

• I understand that being in contact with friends, people in jail or prison, or family that is not my immediate family, is not in my best interest while I am a client of H.O.H.

• I am here to work on myself and I realize that being in communication with too many people will take the focus off my-self and my recovery.

• All my mail will be unsealed before mailing it out or opened by staff.

• Make a list of immediate family for H.O.H. to set up with phone use.

 

        Name: ______________________________________________

        Relationship_________________________________________

        Phone # ____________________________________________

 

        Name: _______________________________________________

        Relationship__________________________________________

        Phone #______________________________________________

 

        Name: ________________________________________________

        Relationship___________________________________________

        Phone # _______________________________________________

 

        Name: ________________________________________________

        Relationship___________________________________________

        Phone # ______________________________________________