Client Forms
Release of Information
Self. This form authorizes Hope Springs Behavioral Consultants to share your records with a designated provider or clinic.
Once we have a Release of Information (ROI) form on file, we are able to send information to the person or provider listed on the form. Please complete a separate form for each clinic or provider you wish to authorize.
Before you begin
- 1You must be completing this form for yourself as the client.
- 2Have the name and contact information of the provider or clinic you are authorizing ready.
- 3Complete a separate form for each provider you wish to authorize.
- 4Submissions are reviewed by our administrative team. You will be contacted if any information is missing.
Release of Information — Self
Other release forms
Need help?
If you have questions about this form or need assistance, our team is happy to help.