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Forms

The following forms will help you get started. Please download them and look them over, so that your first appointment will be productive.

Client Intake Questionnaire

Limits of Confidentiality

Authorization for Release of Information

Page Speiser LCSW
275 East South Temple
Suite 101
Salt Lake City, Utah 84111
801-252-6853  
  • 275 East South Temple Suite 101 Salt Lake City, Utah 84111
  • 801-252-6853  | 
A Website by Brighter Vision
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