Privacy & records
Release of Information
A written authorization may be needed when you want the practice to share counseling records or communicate with another person or organization.
Request an authorization form
Call your therapist at 440-201-4841 to request the current Authorization to Release Information form and instructions for returning it securely.
Protect your information: Do not send completed release forms, diagnoses, treatment details, or other sensitive health information through this website or an unsecured message.
Information you may be asked to provide
The authorization process may ask you to identify:
- The person or organization permitted to receive information
- The specific records or information covered
- The purpose of the disclosure
- An expiration date or event
- Your signature and the date
Your therapist can answer questions about the form, its limits, and how to revoke an authorization when applicable.
Records and treatment communication
Different rules may apply depending on the information requested and the purpose of the disclosure. The practice will review each request and use an appropriate, current authorization process.