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We just need a few more forms signed and you are on your way to Divine Counseling and Wellness!

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Divine Counseling and Wellness,Inc


Please read, initial, sign, and date.

I authorize DC&W to release or receive my mental health information (a) to any requesting health/medical care provider for further diagnosis, care, treatment, or for that provider’s payment or health care operation purposes; (b) to any person or entity which may be responsible for billing and/or collection of claims for medical or mental health services rendered; (c) to any third-party payers (i.e. Medicare of Medicaid).

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