RELEASE OF INFORMATION AND CONSULTATION
LONE STAR COUNSELING SOLUTIONS

BROOK ZEMEL, PH.D., LPC-S

281-703-7400

920 E. BLANCO, STE. B, BOERNE, TEXAS, 78006

4010 BLUE BONNET BLVD., STE. 216, HOUSTON, TEXAS, 77025

BROOK@LONESTARCOUNSELINGSOLUTIONS.COM


I have informed (any additional therapist)Dr./Mr./Ms.: , address: , phone: and they have approved my meeting with Brook Zemel, Ph.D., LPC-S to receive counseling services. I give permission to Brook Zemel, Ph.D., LPC-S to speak with and receive records from Dr./Mr./Ms. for the purpose of giving and receiving information for coordination of my treatment.

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