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AGREEMENT
By submitting this information, I declare that I currently hold a valid license as an LCSW, MFT, LPC, Psychologist, or Psychiatrist. I also agree to provide service in accordance with the legal and ethical standards of my profession. This includes my obligations to provide services within my scope of practice, my responsibility to obtain consultation/supervision when indicated, and my duty to make appropriate referrals when necessary. Additionally, I have malpractice insurance and I agree to fax or mail proof of insurance to: |
