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Self Regulation Therapy (SRT)
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Home
About
Investment
Self Regulation Therapy (SRT)
Contact us
Consent for Release
Consent for Release
Consent for Release
Megan
2022-06-14T14:36:30-07:00
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certify that I have consulted with my therapist, and I consent to the release of confidential information concerning myself or SAFETY PLANNING, AND SERVICE COORDINATION. I CONSENT TO RELEASE AND TO COLLECTION OF CONFIDENTIAL INFORMATION BETWEEN MELISSA TWOMEY & THE FOLLOWING PROFESIONAL/INDIVIDUAL AND/OR SERVICE PROVIDERS FOR THE PURPOSE DESCRIBED ABOVE.
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