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Release of Information

SOLUTIONS PARENTING SUPPORT
PARENT COACHING AND TRANSITIONAL SERVICES

AUTHORIZATION TO RELEASE INFORMATION TO SOLUTIONS PARENTING SUPPORT

  • I hereby authorize the release and disclosure of any information that can be provided regarding the therapeutic work that is being or has been provided in relationship to parenting support and our family system.
    Purpose: The client’s identifiable health information received pursuant to this release authorization is to be used for the following purposes: Treatment overview and recommendations of said client, their family system and will not be released to anyone but Solutions Parenting Support.
  • This field is for validation purposes and should be left unchanged.