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This authorization for Release of information is given freely voluntarily and without coercion. Signature Date Witness Signature of person authorized to sign in lieu of client Guardian/Conservator 4800 Whitesport Circle Ste 2 Huntsville AL 35801 256 533-9393 Fax 256 533-9690 100 Essex Court Ste A Madison AL 35758 256 325-2388 Fax 256 325-2395 apsc alapsych. Psychological or psychiatric evaluations s reports assessments treatment notes summaries or other documents with diagnoses prognoses...
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