If you would like me to coordinate care with another provider such as your psychiatrist or primary care physician, complete this form to authorize release of psychotherapy information:

Kim Shaffer, LCPC,
Counseling Services, LLC.
2025 Glenwood Ave
Hermon, ME 04401
Phone: 207-991-5818
Fax: 1-888-977-1705
If you would like me to coordinate care with another provider such as your psychiatrist or primary care physician, complete this form to authorize release of psychotherapy information: