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By checking this box (required), I certify that I have read this statement and agree to its terms: If you are considering harming yourself or someone else or are in need of IMMEDIATE crisis counseling assistance, please call Utah's Crisis Line at 801-587-3000 or the National Suicide Prevention Hotline at 1-800-273-8255 24 hours a day/ 7 days a week. For life threatening emergencies, please call 911. The use of email or this form for communication does not establish a therapist-client relationship. *

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