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Deborah Kourgelis, LCSW, LCADC
2022-11-22T18:40:46+00:00
Please download the below forms, complete and send or fax back to us.
Cancellation Policy
Clinical History Form
Consent for Treatment of a Minor
Credit Card Authorization
Informed Consent Form
Personal Information Sheet
Statement of Confidentiality
Telemental Health Informed Consent
Authorization for Electronic Communication
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