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I hereby authorize the release of the results of this questionnaire / assessments to Future Psych Solutions for the purpose of clinical evaluation, diagnosis, and coordination of care. I understand that this information will be used by my healthcare provider to better understand my mental health status and to support treatment planning. I understand that this questionnaire / assessment is a standardized tool to assess the severity of depressive symptoms. My responses and results will be kept confidential and used solely for clinical purposes. I understand that I have the right to revoke this consent at any time by submitting a written request, except to the extent that action has already been taken based on this authorization.