Recovery Program Fee Agreement Confirmation


Center for Family Development

1258 High Street, Eugene, OR 97401 - 541-342-8437 / Fax 541-242-2999

Recovery Program Fee Agreement Confirmation

Full Name:   Date of birth:

I have reviewed the Recovery Program Fee Agreement completed by my therapist.

                   


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Signature Certificate
Document name: Recovery Program Fee Agreement Confirmation
lock iconUnique Document ID: 2eb79e9379d7dd8d1559a62b9eb816c7a6607fb1
Timestamp Audit
December 4, 2020 11:43 am PSTRecovery Program Fee Agreement Confirmation Uploaded by Jason Dooley - jdooley@c-f-d.org IP 65.157.96.202