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but am NOT currently providing
Sometimes it just helps to talk
If Dr. Smith has asked you to submit these forms after completion, please click here →
Release of Information
Release of Information - If you would like me to speak to another person regarding your case, this form must be completed and signed. People with whom you would like me to speak may include anyone such as another treatment provider, an attorney, or a close family member. If I am contacted by someone regarding your case and I DO NOT have this authorization, I will maintain my commitment to confidentiality and not even acknowledge whether or not you are in treatment with me.
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