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Blue Mountains
Blue Mountains

Helpful Forms

 

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information.  Additionally, if there is another individual you would like to give permission to have access to some or all of your confidential information, please use the form below:

Authorization for Release of Confidential Information


Note: To download Adobe Acrobat Reader for free, click here.

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Helpful Forms

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