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Candice Sapiro Hicks LMHC 6735 Conroy Road Suite 207 Orlando FL 32835 P 407 790-9584 F 407 477-5514 MASTER TREATMENT PLAN CONSENT I understand I am an active participant in my treatment process. ASSIGNMENT OF INSURANCE BENEFITS I hereby assign all medical and psychotherapy benefits to which I am entitled including Medicare private insurance and/or other health plan benefits to Candice Sapiro Hicks LMHC. This assignment will remain in effect until revoked by me in writing. A photocopy of this...
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