Submit a release form to share your health information with another provider, agency, or third party.

If you need your records shared with another therapist, healthcare provider, attorney, or organization, you’ll need to complete an Authorization for Release of Health Information form.

This form allows us to release specific records only with your written consent — in accordance with HIPAA privacy regulations.

This section-by-section guide will help ensure your form is completed accurately and processed without delay.

When filling out your authorization form:

♥ Clearly specify what information you want shared (e.g., progress notes, summaries, treatment plans).

♥ Identify to whom the information should be released (name, organization, and contact details).

♥ Include dates of service or timeframes relevant to your request.

♥ Sign and date the form electronically or by hand to authorize release.