Home
About
Services Provided
Getting Started
Helpful Resources
- Mental Health Links
- Physical Health Links
Contact

803-250-6410 | AnthonyHamptonTherapy@gmail.com

Anthony Hampton Therapy

Don't Wait to Get the Help You Need Start Here

Authorization for Release of Information copy

September 1, 2016 by NTHHMPTN63469 Leave a Comment

Authorization for Release of Information copy

2210 Devine St.
Columbia, SC 29205

803-250-6410
AnthonyHamptonTherapy@gmail.com

Send a Message

Name *

E-mail *

Phone

Comment or Message

Terms of Use *

Yes, I want to submit this form

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Message

A Bright Site by Brighter Vision

Copyright © 2024 · Bubbles on Genesis Framework · WordPress · Log in