Below are authorizations that you might find helpful in situations where you need to request records, authorize your child to be seen, or authorize an individual to speak with us on your behalf. The forms are HIPAA compliant and will remain in effect until the date of your choice.
If you have questions about any of the authorizations, please reach out to our office (see Contact Us) and we will do our best to help out.
Authorization for Release of Medical Information - Individual
Authorization to Release Medical Information - Office/Facility
Authorization to Treat Patient without Parent or Guardian