Client Information Form

WARNING: If this is an emergency, contact DPS 202-651-5555 (voice or text), or (email) or call 911 immediately.
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Note: unencrypted email is not a secure form of communication. There is some risk that individually identifiable health information that may be contained in such email could be misdirected, disclosed to or intercepted by unauthorized third parties. By clicking Yes, you indicate that you understand the risk.*


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