*If there is not an individual or organization you want Supportive Solutions to have verbal or written contact, please do not complete form*

This form allows Supportive Solutions, LLC Staff to verbally communicate with the Individual, Agency, Organization, or Company (including Insurance Company) that you identify below. The information exchanged will be on a need to know basis that focuses on supporting your counseling services and goals.  

Name/Address of Agency, Organization or Individual to Whom Information is to be Released/exchanged

Supportive Solutions, LLC
5881 Glenridge Drive Suite 240 Sandy Springs, GA 30328
(404) 955-8167
www.supportivesolutionsga.com