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Privacy Practices Receipt
Step 5
Client Name:
If signing for a minor, please provide full legal name of legal guardian
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Acceptance | Privacy Practices Receipt
I hereby acknowledge that I have received and been given an opportunity to read a copy of the Notice of Privacy Practices of Carrie T. Ishee. I understand if I have any questions regarding the Notice or my privacy rights, I can contact Carrie T. Ishee, M.A., LPCC, LPAT, ATR-BC, PCC, Privacy Officer.
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