Release of Confidential Information

There may be times when you need me to speak to someone right away, but are unable to make a separate trip to my office to provide me with your written consent. In this case, you can download the necessary form here in a PDF file, print it, complete it, sign it and fax it back to my confidential fax number and/or send the hardcopy to me by mail.

Note: this form is not part of the regular intake package. Completing this form is only for those occasions when you may want me to communicate with a third party.