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patient forms

Patient forms

Please complete the following forms and bring them with you to your appointment.

  • Client Information Form (MS Word or PDF)
  • Release of Information (MS Word or PDF)
  • Treatment Consent (MS Word or PDF)
  • Notice of Privacy Practices (PDF)
  • Acknowledgment of Receipt of Notice of Privacy Practices (MS Word or PDF)



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Angela H. Annas, LCSW
(919) 623-4481 Fax (919) 942-8409

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