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Willougbhy Bay P.O. Box 3592, St. John s, Antigua W.I. Phone: 268-562-0035 Fax: 268-562-0036 CONSENT FOR THE RELEASE OF CONFIDENTIAL INFORMATION I, authorize (PRINT CLIENT S NAME) CROSSROADS Center
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The consent form - Crossroads is a document that allows the individual to give their permission or approval for a specific action or procedure related to the Crossroads program.
Participants of the Crossroads program are required to file the consent form.
To fill out the consent form for Crossroads, participants need to provide their personal information, sign the form, and indicate their consent for the specified actions or procedures.
The purpose of the consent form for Crossroads is to ensure that participants understand and agree to the actions or procedures involved in the program.
The consent form for Crossroads must include the participant's personal information, details of the actions or procedures requiring consent, and the participant's signature.
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Antigua IMPORANT RECOMM Willoughby PSYCHOSOCIAL COND dissemination AFTERCARE EVAL Specification applicable reliance herein governing REFERRAL revoke exempt sender disclosed disclosure expires recipient copying INTAKE prohibited RECOMMENDATIONS VISITATION

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