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Get Counseling Release Of Information Template

Gloria Smith Counseling Gloria Smith, MA, LMFT, LPC 15303 Huebner Road, Bldg 10 San Antonio, Texas 78248 Phone (210) 4972880 Fax (210) 5260387 RELEASE OF INFORMATION I, , give my consent for Gloria.

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  3. Fill in the blank areas; involved parties names, places of residence and phone numbers etc.
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  5. Include the particular date and place your e-signature.
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