Authorization to Release Information (ROI) Form

$5.00

This Authorization to Release Information Form allows clients to give informed consent for sharing specific PHI with designated providers or agencies.

Includes recipient, purpose, scope, expiration, and signature.

This Authorization to Release Information Form allows clients to give informed consent for sharing specific PHI with designated providers or agencies.

Includes recipient, purpose, scope, expiration, and signature.

Complete Neuroinclusive Therapy Intake Packet – 70 Pages

$59.00

Neuroinclusive Client Intake Form

$15.00

Authorization to Release Information (ROI) Form

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