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Consent to Use Telemedicine SOUTHERN CALIFORNIA PSYCHIATRIC GROUP, INC 28125 BRADLEY RD, STE 220, SUN CITY, CA 92586PATIENT NAME: ___ DATE OF BIRTH: ___ CURRENT PATIENT LOCATION: ___, CALIFORNIA I,
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Visit the Southern California Psychiatric Group website or contact their office to obtain a copy of the SOUFORNRN form.
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Carefully read through the instructions on the form to ensure you understand the information needed.
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Fill out all required fields on the form, including personal information, medical history, and any additional details requested.
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Double-check your entries for accuracy and completeness before submitting the form.
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Submit the completed SOUFORNRN form to the Southern California Psychiatric Group through their specified method, such as in person, via mail, or through their online portal.

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Individuals who are seeking psychiatric services in Southern California and are clients or potential clients of the Southern California Psychiatric Group.
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Souformrn California Psychiatric Group is a form used for reporting psychiatric services in California.
Psychiatric professionals and facilities in California are required to file Souformrn California Psychiatric Group.
Souformrn California Psychiatric Group can be filled out by providing information on psychiatric services provided, patient details, billing information, and other required data.
The purpose of Souformrn California Psychiatric Group is to report and track psychiatric services provided in the state.
Information such as psychiatric services provided, patient demographics, billing details, and other relevant data must be reported on Souformrn California Psychiatric Group.
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