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Renewed Journey Counseling Services, LLC 1479 Crockett Road Suite 101 Tucker, GA 30084 O: (404) 6255427 F: (404) 5088944 www.renewedjourney.org INFORMED CONSENT FOR MEDICATION Patient Name: Birthdate:

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625-5427 f - renewed is a form used for renewing a specific type of license or registration.

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