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4325 Laurel Street Suite 230 B Anchorage, AK 99508 pH. 907.561.3337 Fax 907.561.3322 Concept3 LLC Leigh M. Reeve, MA, LPC Authorization for Release of Client Information (Please confirm Receipt via

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Start by writing the recipient's name or organization on the first line. For example, if it is a business, write the business name. If it is an individual, write their full name.

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