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Forms (for school based and telehealth services only)
Please print, complete thoroughly, sign/date, initial (in indicated spots), and return to anita.lovell@qlcne.com or mail to P.O. Box 204 Adams, Ne 68301 prior to your first appt.
Initial Intake Paperwork:
Informed Consent:
HIPAA:
Notice of Privacy Practices:
Confidentiality:
Client Rights & Responsibilities:
Any other required documentation will be emailed by your therapist!
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