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

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