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snssokc.comsnssokc.com/pdf/intakeforms/intake_forms.pdfPatient Consent for Use and Disclosure of Protected Health Information With my consent, Dr. Barry and/or Dr. Spence may use and

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Page 1: snssokc.comsnssokc.com/pdf/intakeforms/intake_forms.pdfPatient Consent for Use and Disclosure of Protected Health Information With my consent, Dr. Barry and/or Dr. Spence may use and
Page 2: snssokc.comsnssokc.com/pdf/intakeforms/intake_forms.pdfPatient Consent for Use and Disclosure of Protected Health Information With my consent, Dr. Barry and/or Dr. Spence may use and
Page 3: snssokc.comsnssokc.com/pdf/intakeforms/intake_forms.pdfPatient Consent for Use and Disclosure of Protected Health Information With my consent, Dr. Barry and/or Dr. Spence may use and
Page 4: snssokc.comsnssokc.com/pdf/intakeforms/intake_forms.pdfPatient Consent for Use and Disclosure of Protected Health Information With my consent, Dr. Barry and/or Dr. Spence may use and
Page 5: snssokc.comsnssokc.com/pdf/intakeforms/intake_forms.pdfPatient Consent for Use and Disclosure of Protected Health Information With my consent, Dr. Barry and/or Dr. Spence may use and
Page 6: snssokc.comsnssokc.com/pdf/intakeforms/intake_forms.pdfPatient Consent for Use and Disclosure of Protected Health Information With my consent, Dr. Barry and/or Dr. Spence may use and
Page 7: snssokc.comsnssokc.com/pdf/intakeforms/intake_forms.pdfPatient Consent for Use and Disclosure of Protected Health Information With my consent, Dr. Barry and/or Dr. Spence may use and