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Authorization + Acknowledgments
Please click the image below to fill, print and sign this form prior to your first appointment.
Client Information + Assessment
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Notice of Privacy Practices (Read Only)
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Authorization for Release of Info (As Requested)
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Personal Information Update (As Requested)
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The Rooted Heart
Transformational counseling with Dina Varano. EMDR, IFS, hypnotherapy, and mindfulness.
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317 590 5351
dina@t
herootedheart.com
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