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Authorization for Release of Information Stacey LavesKhalifa, LPC, LEFT, LCD CRE: Birthdate: Address: This will authorize (Name and Address)to release to Stacey LavesKhalifa information from the clinical
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Stacey Laves-Khalifa, LPC, LMFT is a licensed professional counselor and licensed marriage and family therapist.
Individuals seeking counseling or therapy services typically do not file anything related to Stacey Laves-Khalifa; it is the professional who may need to submit documentation for licensing or treatment purposes.
To fill out any forms related to Stacey Laves-Khalifa's services, one should provide personal information, the nature of the therapy needed, and any relevant medical history as directed.
The purpose of Stacey Laves-Khalifa's services is to provide mental health support, counseling, and therapy to individuals or couples facing mental health challenges.
Clients may be required to report personal identification details, health history, insurance information, and the specific issues they are seeking help with.
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