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Consent Service Form Version 2

Prior to your first appointment, please complete the following consent form if:
(a) you are not claiming these service under an extended health plan OR
(b) your extended health plan covers "Psychotherapy Services".

The information will be submitted electronically using encryption and will remain confidential, and not be shared with anyone without your written consent.

Abma Counselling Services 

Consent Form Version 1

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