Consent / Refusal for Collaboration

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I give permission for DV Therapy to discuss and release information to the behavioral health clinician.
My child does not have a behavioral health clinician.

Behavioral health clinician:

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Clinician's Address
My child does not have a primary care physician.

Primary care physician

Physician Name
Physician Address
I give permission for DV Therapy to discuss and release information to the primary care physician.(Required)
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5 star ratingI love bringing my little one here. I've notice such a big difference in her speech. And Ms.Rachel is amazing... read more

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Bianca C.
1 month ago

My 2 year old son has been improving so much over the last few months & im very thankful for... read more

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Stephanie D.
7 months ago

Im beyond happy with the services my daughter is receiving. Her therapist Lupe has done an amazing job, from keeping... read more

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Ness M.
1 year ago
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