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PROFESSIONAL DISCLOSURE STATEMENT Andrew R. Gal breath, MSW, LCSW, CDP Wilbur ton Ridge Office Park 345 118 Ave SE, Suite 100 Bellevue, WA 98005 Phone: 425.681.3640 TH I appreciate your willingness

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Information such as participant's name, date, signature, and any relevant details about the situation or activity must be reported on arg informed consentdocx.

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