Release of Confidential Information

On occasion, you may want your therapist to communicate with a third-party about your confidential information. Your written authorization is required in these cases (with some exceptions which are clearly explained up front at the start of therapy).

There may be times when you need your therapist to speak to someone right away, but are unable to make a separate trip to our office to provide us 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 our confidential fax number (403-255-8570), or scan it and email it back to us, or send the hardcopy to us by mail.

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

Top | Home