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Please return form to: 17 Forest Ave., Suite 14 Fond du Lac, WI 54935 or fax to: 9209293686 Individualized Youth Services Received: Referral for Emotional Disturbance Reviewed: Completed By: Date:
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The 'please return form to' is a form that needs to be submitted to the designated recipient.
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The purpose of the form is to gather specific information from the filer and transmit it to the designated recipient.
The required information may vary depending on the form instructions, but typically includes personal or business details.
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