Hi, please rewrite and create opportunity and declaration for mental health treatment form see the model below and follow everything but don’t copy exact for copy write purposes: see attachment below

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Hi, please rewrite and create opportunity and declaration for mental health treatment form see the model below and follow everything but don’t copy exact for copy write purposes: see attachment below 

https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le9550.pdf