Deborah Lee Urban, MEd, NCC, LPC
This form is for the purposes of giving me the permission to have contact with person(s)/organization(s) regarding your care or the care of another of whom you are the guardian. This form will be submitted to my email: DebbieUrbanLPC@aol.com. If you have any reservations or questions about this form, please contact me by email or call: (314) 304-2942.
Copyright © 2004-8 Deborah Lee Urban. All rights reserved.
Revised: March 28, 2010.