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1821 Pickens Street Columbia, South Carolina 29201

(803) 232-5548

kwbenjamin@palmettomentalhealthcounseling.com

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1821 Pickens Street
Columbia, South Carolina 29201

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(803) 232-5548

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By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.