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Patient Services Contact Form


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Confidentiality Agreement

To ensure privacy protection as part of the Health Insurance Portability and Accountability Act (HIPAA) and to provide indivicuals with control over what personal information is used and disclosed, I agree to provide the above information to Sue's Gift.

Questions?

Please contact Sherry Martin, LCSW, Patient Services Director, at 719-422-9964 or sherry@suesgift.org.