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Lynn Davilla Shields
LYNN DAVILLA SHIELDS, PHD
Signature Page
Please print and bring with you to sign at our first visit.
I have read and understand the following documents and have been given the opportunity to discuss all my questions about them with Dr. Shields.
Psychotherapist-Patient Services Agreement
Notice of Psychologists’ Policies and Practices to Protect the Privacy of Your Health Information (HIPPA)
Name:
Signature:
Date:
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