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Release of Information Form

Minor

INSTRUCTIONS

Print Form:

  1. Click the square and arrow in the top right corner of this form to "pop out" the document in order to print and/or download the form.
  2. Have the client fill out the form, sign, and date.
  3. Scan the form or take a picture of the form
  4. Email the scanned form or picture of the form to Marketing Director, Alex Dunn, adunn@eastersealsma.org

Digital Signature:

  1. If the client would like to sign this form digitally, simply have the client and/or staff email Marketing Director, Alex Dunn, adunn@eastersealsma.org with the subject line "digital signature consent"
  2. Please note, the marketing director needs the email of the person signing the form to complete this process.
  3. No software or downloads are required to provide a digital signature once the marketing director has the email address of the person required to sign the form.
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