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Samaritan Health and Living Center
Therapy for Individuals, Couples, & Families
574-262-3597
ADULTS (18+)
Consent to Treat
Fee Assistance App
Initial Questionaire
Permission to Share
Release of Information
HIPAA Privacy Practices
HIPAA Receipt of Policy
Statement of Agreement
Cross-Cutting Measure
Child in Waiting Room Policy
Cr. Card Authorization
Consent to Zoom Teletherapy
TEEN (13 - 17)
Waiting Room & Therapy Policy
CHILDREN (12 and younger)