Release of Information Form

Mount Comfort Counseling Services

P. O. Box 3381, Fayetteville AR 72702
3281 W. Mt Comfort Road
Fayetteville AR 72704
Glenda Davis, MSC, LMFT, LPC – Therapist


The purpose of this form is to inform you about various contact methods and the restrictions that apply. This will allow us to provide you with the best care while maintaining your privacy.

In the interest of privacy, it is considered good practice for therapists not to be Facebook friends with their clients. Therefore friend requests and Instant Messages may be ignored.

Name of Patient or Responsible Party

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