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Forms

HIPAA Privacy Practices Notice (pdf)

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Informed Consent (pdf)

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Intake Form (pdf)

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Out of Network Insurance Details (pdf)

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Release Exchange of Information (pdf)

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Telehealth Informed Consent (pdf)

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Restoration Counseling of Rochester, pllc

500 Canal View Blvd, Suite 400 | Rochester, New York 14623

585-733-9465 | joyce@restorationcor.com

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Photos Courtesy of Mark Logan