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Life Skills Institute & Clinic Margaret Green, Ed. D., L.P. 15710 Day Place Minnetonka, MN 55345 RE: Consent to use and disclose your health informational Patient, This form is an agreement between

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How to fill out re consent to use

01

Start by opening the re consent form.

02

Read the instructions carefully to understand the purpose of the consent form.

03

Fill out your personal details such as name, address, and contact information.

04

Specify the specific consent you are giving or revoking in the form.

05

Provide any additional information or details requested in the form.

06

Review the completed form to ensure all information is accurate and complete.

07

Sign and date the form to indicate your consent or revocation.

08

Submit the completed form following the instructions provided.

Who needs re consent to use?

01

Anyone who wishes to give or revoke consent to use their personal information needs to fill out a re consent form. This could include individuals who have previously given consent but wish to change their decision, or individuals who are required by law to provide explicit consent for the use of their personal data.

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