Release of Information Form
Adult
INSTRUCTIONS
Print Form:
- 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.
- Have the client fill out the form, sign, and date.
- Scan the form or take a picture of the form
- Email the scanned form or picture of the form to Marketing Director, Charlene Leith.
Digital Signature:
- If the client would like to sign this form digitally, simply have the client and/or staff email Marketing Director, Charlene Leith with the subject line "digital signature consent"
- Please note, the marketing director needs the email of the person signing the form to complete this process.
- 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.
