Begin Your Path to Healing.
Begin Your Path to Healing.

Release of Information Form

Consent for Consultation and Release of Information

In order to give you the best possible service, you may request that I give or receive information to/from other organisations, professionals or people nominated by you.  Before information is shared, I will discuss with you what information you require to be given/received, why it needs to be shared and what it will be used for. Any discussions or information conveyed with other providers/people will only focus on what is relevant to your situation and what supports you may need.

Prefer to print and fill out your form in person?

Release of Information Form

I
Give permission for
to convey and/or obtain relevant information for referral, reporting purposes and treatment plans including/outlining:
Client:
By signing this form you are giving permission for Sara Martin to give your information to another person, organisation or professional.
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