Get the free 215-836-4276 215-233-1081 (FAX)

Joseph L. Nines, Ph.D., L.M.F.T. Licensed Marriage and Family Therapist2158364276 2152331081 (FAX) AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION (Page 1 of 2) 1. Clients name:

How to fill out 215-836-4276 215-233-1081 fax

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