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Trailhead Counseling Services

I understand that this form is not a HIPAA compliant means of communication. I understand that the most confidential way of communicating with Michael Schiferl is by calling (816) 875-0072. I acknowledge that, while Michael Schiferl will attempt to protect this information, the nature of this form means he cannot guarantee my privacy. I also acknowledge that I must be 18 years of age or older to submit this form.