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Consent to Treatmeant and Relase of Information
 

Please fill out the following form
in order to participate in our activity.

I authorize the staff of Central Texas Therapy Spot, PLLC to:

1.

2.

3.

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I agree and understand that by signing the Electronic Signature Acknowledgment and Consent Form, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.

Thanks for submitting!

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