School Educator Meetings
This form will take approximately less than 10 minutes to complete.

School Educator Meetings

  • This authorization is effective for a period of one (1) year from the signature date or as otherwise specified.

    After the effective date, this Authorization to use or disclose this Protected Health Information expires. I understand that I have the right to revoke this Authorization, in writing, at any time by sending such written notification to Chosen, located at 351 Main Plaza, New Braunfels, Texas 78130. This authorization has been read to me/or by meand I understand its meaning.
 

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