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Communication Preference Form


In an effort to ensure your privacy, it is important for us to understand your preferred method of receiving and communicating medical and administrative information pertaining to your therapy. As such, please indicate your communication preferences below.

For medical and administrative information pertaining to me, such as, clinical documentation, appointment reminders, therapy updates, etc., I hereby grant permission to Branched Out Therapy, Inc. to do the following:


Sharing of Information


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