By signing below, I am authorizing Kate Walker, LCSW to use and disclose my protected health information for the purposes of directing treatment and/or consultation or other purposes as I may direct
This authorization shall be in effect for one year from the date of the signature below unless otherwise expressed.
I understand I have the right to revoke this authorization, in writing, at any time.
I understand that my treatment will not be conditioned on whether I sign this authorization.
I understand that information used or disclosed pursuant to this authorization may be disclosed by the recipient and may no longer be protected by federal or state law.