Covenant Family Services (ip host:) 216.110.144.248 United States Illinois Chicago 60606 | 03.05.2016 13:27:08

Covenant Family Services, LLC.550 New Haven AvenueMilford, CT 06460Phone: 203-446-1848Fax: 203-283-7714RELEASE OF PROTECTED HEALTH INFORMATION www.covenantfamilyservices.net 31.01.2016 07:05:47 http://www.covenantfamilyservices.net/wp-content/uploads/2013/04/Release-of-Information.docx

Covenant Family Services (203) 446-1848(T) 550 New Haven Ave, Milford CT 06460 (203) 283-7714 (F) Family’s Information Form (p. 1 of 3). Covenant Family Services (203) 446-1848(T) 550 New Haven ... 31.01.2016 07:05:47 http://www.covenantfamilyservices.net/wp-content/uploads/2013/04/Intake-form.pdf

Covenant Family Services, LLC (203) 446-1848 (T) 580 Naugatuck Avenue, Milford, CT 06460 (203) 283-7741 (F) Informed Consent (p 1 of 2) Welcome to Covenant ... Informed Consent (p 1 of 2) - Covenant Family Services 31.01.2016 07:05:47 http://www.covenantfamilyservices.net/wp-content/uploads/2014/11/Informed-Consent.pdf

Covenant Family Services (203) 446-1848(T) 580 Naugatuck Ave, Milford CT 06461 (203) 283-7714 (F) Family ’s Information Form (p. 1 of 3). Today ’sDate Family ’s Information Form (p. 1 of 3). 31.01.2016 07:05:47 http://www.covenantfamilyservices.net/wp-content/uploads/2014/11/Family-Information-Form.pdf

RELEASE OF PROTECTED HEALTH INFORMATION Covenant Family Services, LLC. 550 New Haven Avenue Milford, CT 06460 Phone: 203-446-1848 Fax: 203-283-7714 Covenant Family Services, LLC. 550 New Haven Avenue ... 31.01.2016 07:05:47 http://www.covenantfamilyservices.net/wp-content/uploads/2014/06/Release-of-Information.pdf

Marcel is a Marriage and Family Therapist with a master’s degree from Southern Connecticut State University. He has one year specialized training in ... Marcel -Covenant Family Services 31.01.2016 07:05:47 http://www.covenantfamilyservices.net/?page_id=7