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THERAPIST # CASE # PFEIFFER INSTITUTE REACH CHILD/ADOLESCENT INFORMATION Please print clearly and check the answers that apply: Legal Guardian Information: Name: Today's Date: Address: City: State:
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Please print clearly and refers to the instruction to fill out a form in a legible manner.
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The purpose of please print clearly and is to ensure that the information provided on the form is easily readable and correctly interpreted by the recipient.
Any information that is required on the form must be reported clearly and legibly according to the please print clearly and instruction.
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