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No Yes Substance Onset of use Still using Frequency of Use VIII. Professional Contacts Please provide a list of all professional contacts e.g. psychologists therapists educators ecclesiastical leaders who knows the client and can speak to any concerns. Additionally please furnish a copy of this release to each of these professionals. Email Relationship Do you want us to contact this person No Yes IX. Briefly describe what was effective about this treatment and what was not. VI. Medical...
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Start by writing the first and last name of the person filling out the form.
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The name of the person filling is the individual who is completing the required form or document.
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To fill out the name of the person filling, simply write your full name as it appears on official documents.
The purpose of providing the name of the person filling is to identify who completed the form or document.
The name of the person filling must include their first name, last name, and any necessary middle names or initials.
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