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1902 Fairfax Ave Cherry Hill NJ 08003

Consent to Continue Services in Another Location

Consent to Continue Services in Another Location

  • I hereby give permission to representatives of Connect Plus Therapy to contact the below listed individuals in regard to my child of this form. Representatives of Connect Plus and these individuals may both share confidential information with each other including written reports, verbal consultation, and email consultation.
  • Date Format: MM slash DD slash YYYY