Consent & authorization to release information
If there are other parties that may assist in your therapy and you believe it would be helpful for your counselor to contact them regarding your treatment, please read carefully and complete this document.
The following is an authorization for the stated parties to consult with one another regarding your treatment process. Information shared is for the sole purpose of facilitating maximum care to you as the client. Please provide the necessary information and your signature with today’s date as indicated below.
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