I authorize Freedom Counseling, LLC to discuss and exchange, in verbal or written form, any relevant information to my or my child’s treatment with the person, or any person(s) or staff of the institution, named below.
You may revoke this consent at any time. Unless otherwise revoked or renewed, this consent is in effect for one year from the date of the last session. This consent is subject to all conditions outlined in the Notice of Privacy Practices.
