I was under the impression that this form was designed (and needed) to show that an individual had an informed choice of providers when choosing service providers. This form only shows the providers that have been chosen, not the ones that were declined. If there is NO requirement to document the providers who were not chosen, this is fine.  But per Kaitlyn Graham's comment, if this is still a requirement, this form creates an additional documentation need and needs to be revised to complete the full required task.