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Authorization for Release of Information 1) Client name:Date of birth:2) I, parent of give my authorization for Children's Speech and Language Services of Springfield, LLC to exchange information
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1 client name refers to the name of a specific client or customer.
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Anyone who has a business relationship with the client or customer may be required to file their name.
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The information reported on a client name may include the full name of the client, contact information, and any relevant details about the business relationship.
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