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    Informed Consent and Consent to Therapy
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    Notice of Privacy Practices - HIPPA
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    Intake Form/Personal History
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    Release of Information - Medical​
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    Release of Information - Friends and Family

     Carilyn Ellis, PsyD, MSCP

    3857 Wolverine Dr NE, Office C6

    Salem, OR 97305

    Phone: (503) 856-6430

    Fax: (503) 877-1920  

    Email: AutumnLeafTherapy@gmail.com

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