NC Parenting coordinator contact FORM

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First Name

Last Name

Phone *

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By clicking this box, I understand that PC services are not a medical intervention, and are not covered by health insurance. *

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I agree with the privacy policy, and understand that this form is not a secure form of communication.

I agree to receive SMS text messages from Kenny Levine, LCSW for scheduling purposes only. I understand that message frequency varies and data rates may apply. I understand that I may opt-out by replying "STOP" at any time. I understand that I may reply "HELP" for assistance. I understand consent is not required to purchase goods or services. Kenny Levine, LCSW does not use text messages for marketing purposes.

I agree to receive text messages for scheduling purposes.