Home
Services
Getting Started
Payment
Resources
- Mental Health Links
- Physical Health Links
Contact
Blog

573-470-1860 | bgmo.counseling@gmail.com

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

Authorization for Release of Information copy

September 1, 2016 by Heather Miller Leave a Comment

Authorization for Release of Information copy

Bowling Green Counseling and Consulting
(BGCC)

740 Business HWY 61 South Suite B
Bowling Green, MO 63334

573-470-1860
bgmo.counseling@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.

Email

A Bright Site by Brighter Vision

Copyright © 2025 · Bubbles on Genesis Framework · WordPress · Log in