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ANXIETY THERAPY LA AUTHORIZATION TO EXCHANGE & DISCLOSE INFORMATION Name:Birth Date:I hereby authorize Taney Sanofi, Licensed Marriage & Family Therapist (MFT 110024), to request and exchange confidential
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The phrase 'I hereby authorize Tanaz' is typically a statement included in various forms or documents where an individual grants permission or consent for Tanaz to carry out specific actions, usually related to legal, financial, or administrative matters.
Individuals who wish to grant authority to Tanaz for specific actions, such as managing accounts or making decisions on their behalf, are required to file this authorization.
To fill out the 'I hereby authorize Tanaz' document, you need to include your personal information, the specific authority you are granting to Tanaz, and your signature, along with the date.
The purpose of this authorization is to legally empower Tanaz to act on your behalf in certain matters, ensuring that Tanaz can perform tasks or make decisions as specified in the document.
The document must typically report your name, contact information, the scope of authority being granted to Tanaz, and any relevant dates or conditions.
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