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Beth Christensen LMFT Elizabeth Rauch Leftik Psy. D. Susan P. Williams LMFT Sarah E. Wood Ph. D Rupa Zimmermann Ph. Head injury seizures asthma or other illnesses Please list any medications you are taking currently including the dosages. Please describe Alcohol Prescription or street drugs Gambling Overeating/restricting/purging Sex/pornography Video games Has anyone close to you expressed concern about these behaviors Please explain Do you have any legal issues PRINT FORM SAVE FORM. If yes...
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