Consent to be a contact | CRTSS

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Consent to be a contact

First name

Email

Their name

Their Email

Last name

Phone number

Their phone number

Relationship

I give permission for the following person to have contact with my psychologist and the Support Team for any issues related to the administration and practicalities of my appointments (excluding health-related information). I verify that the statements made in this form are correct.

Thank you! We’ll be in touch.

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