Elizabeth A. Hadley MA, MFT
120 S. Elliott Road
Newberg, OR 97132-2928
Records obtained as authorized by this consent for information release will be maintained in accordance with Federal confidentiality regulation (42 CFR, 2), which prohibits further disclosure without written consent of the person to whom it pertains.
Copies of this release are as valid as the original. This release may be revoked in writing at any time except for the extent already relied upon in good faith.
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