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Forms

Patient Registration Form feb 2018

Financial Responsibility

Insurance Info Action Items feb 2018

Permission to Treat feb 2018

Release of Information feb 2018

Privacy Statement

Confidentiality of Records

Consent for Release – General

Consent for Release – Court

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  • EXETER PSYCHOLOGICAL ASSOCIATES, INC.

    ************************************************

    Deborah H. Hamilton, DEd, LICSW

    Cornerstone Commons
    370 Portsmouth Avenue--Suite 7
    Greenland, NH 03840

    tel. 603-692-4060
    fax. 603-372-0804

    ************************************************
    Barbara Beardsley, LCMHC, MLADC, CCFC

    19 Hampton Road, A2
    Exeter, NH 03833

    tel. 603-674-5331
    fax. 603-772-0477

Exeter Psychological Associates