The following forms must be completed and submitted prior to being scheduled with your clinician along with a photo of your government ID (driver’s license, etc.) and insurance card. After the forms are completed, please print, sign, and email them to firstname.lastname@example.org
Release of Info
If you would like to have your provider communicate with any individual, organization, school, or medical provider, a Release of Information Form (ROI) must be completed for each individual entity you are permitting your provider to contact (it is recommended that all Primary Care Physicians, Schools, Psychiatrists, and Spouses have an ROI. It is also a requirement that any potential client under the age of 18 complete an ROI for their legal guardian prior to the initial session).