Authorization

Client’s authorization is required prior to service.

I understand that the information to be released from my record is confidential and protected from disclosure. I also understand that I have the right to cancel my consent to release information at any time before it is released.
I understand that the information to be released from my record is confidential and protected from disclosure. I also understand that I have the right to cancel my consent to release information at any time before it is released.
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