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Hadley Counseling

Hadley Counseling

An exciting journey of healing and self discovery.

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Release Consent Form


Elizabeth A. Hadley MA, LMFT

971-217-7341

CONSENT FOR THE RELEASE OF CONFIDENTIAL INFORMATION

Consent

Items Authorized for Release:

Please check items to be released.

Purpose of Disclosure of Information:

Means of Release

Check all that apply

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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