You may revoke this consent to disclose the above-stated information by notifying the clinician disclosing the information and the person faxing/sending the information that you no longer desire to have your health information disclosed. You may contact these individuals by calling our office or sending them a written notice of your desire to no longer have your health information released.
Please mail your written notice to:
Pattison Professional Counseling & Mediation Center
259 E Oakdale Avenue, Crestview, Fl. 32539 | 850-682-1234
7 Vine Avenue NE, Ft. Walton Beach, Fl. 32548 | 850-863-2873