Get the free Freedom From Smoking - Connections Therapy
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CONNECTIONS THERAPY CENTER
Registration Form
Dr. Cindy Stare, PSD and Associates
8159570115
drcindystear@connectionstherapycenter.comDATE: ___ REFERRED BY: ___ DIAGNOSIS: ___PATIENT NAME: ___BIRTHDATE:
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Begin by gathering all the necessary materials for smoking, such as tobacco, rolling papers, and a smoking device.
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Dom from smoking stands for Declaration of Manufacturing from Smoking. It is a form required to be filed by cigarette manufacturers.
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