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A professional Release of Information (ROI) form designed for therapists and mental health providers who need written client authorization to share confidential information.
This easy-to-use template helps ensure proper documentation when coordinating care, communicating with other providers, or responding to records requests while maintaining compliance with privacy regulations.
Ideal for:
Private practice therapists
Counselors
Social workers
Psychologists
Mental health professionals
Includes sections for:
Client identifying information
Authorized person or organization receiving information
Description of information to be released
Purpose of disclosure
Expiration date
Client signature and date
This customizable ROI form helps protect your practice, maintain clear boundaries, and document client consent properly.
A professional Release of Information (ROI) form designed for therapists and mental health providers who need written client authorization to share confidential information.
This easy-to-use template helps ensure proper documentation when coordinating care, communicating with other providers, or responding to records requests while maintaining compliance with privacy regulations.
Ideal for:
Private practice therapists
Counselors
Social workers
Psychologists
Mental health professionals
Includes sections for:
Client identifying information
Authorized person or organization receiving information
Description of information to be released
Purpose of disclosure
Expiration date
Client signature and date
This customizable ROI form helps protect your practice, maintain clear boundaries, and document client consent properly.