Release of Information

If you want us to release information to a health or mental health professional or others outside the Center, you must fill out and sign an Authorization to Release and/or Obtain Information form.  All sections on both sides of the form must be filled out. If you have questions about what to put in specific items, please call and talk to a clinician or an administrative staff member.

pdf
Updated
1.29.16

Once you have filled it out and signed it on the second page you may hand deliver, fax (207) 581-4975, or mail it to us. You may also complete this form electronically and return it to your therapist by email. This video explains how to do that.