Please send insurance info and drivers license/ID to faxpronto@yahoo.com or fax to 866-394-0482 for benefit check. Consent To Treat and Bill Insurance: I am hereby signing on behalf of myself and/or on behalf of my children to authorize mental health and/or counseling services to be provided by Counseling Centers International (CCI) and/or its counselor/therapists/clinician and/or its licensed subcontractors. I assign benefits of any insurance I may have for these services.
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