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Forms can be filled out electronically through our patient portal. You may also fax completed forms to (844) 479-2683. For individuals who are not a current client of Head and Heart Therapy, it's important to set up a free consultation in order to become a client. 

Informed Consent for Telehealth Services

Personal Disclosure Statement

Release of Information

Maggie Nidick, Student Therapist

Other Forms

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