Skip to content
734-794-3777|info@refreshing-waters.com
FacebookLinkedInTwitterInstagram
Refreshing Waters Counseling Logo
Menu
  • Home
  • About Us
  • Our Team
    • Sheila Burns
    • Amber Cunnings
    • Taryn Konevich
  • Our Services
    • ADHD
    • Alpha-Stim
    • Anger Management
    • Anxiety & Stress
    • Auricular/Ear Acupuncture
    • Career Counseling
    • Children/Teens
    • Christian Counseling
    • DBT
    • Depression
    • EFT
    • EMDR
    • Gender/Identity LGBT
    • Genetic Testing
    • Grief and Loss
    • Life Coach
    • Pre-Marital Counseling
    • Relationship Counseling
    • Substance Use/Addictions
    • Therapy
    • Trauma
  • Resources
    • Patient Reviews
    • Rates/Insurance
    • Patient Portal
    • Employment Opportunities
    • Ann Arbor Medical Community
  • Contact Us

FORM – Release of Information

Home/FORM – Release of Information
FORM – Release of Information2020-04-20T14:02:21-04:00
  • I hereby authorize Refreshing Waters Counseling to release my information to:

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY