Consent to Release Confidential Information Form
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Consent to Release Information to an Outside Party
(33K)Individual therapy consists of 2 parties: you and me. If you would like me to release (share) your confidential information with someone else (third party), you would have to authorize me to do so in writing. Use this form to do so. Print and fill out this form only if you wish to authorize me to communicate about your care with another party (such as your signficant other/relative, physician, previous or another therapist, attorney, etc.)