Release of Information (ROI)
*This form is for current clients.
If you give consent to "release information", you are asking and approve me, Emily Taylor, ATR-BC, LPCC, to the following:
(1) collaborate with your current or past provider at your request, and
(2) allows me to access your primary Diagnostic Assessment (DA) from your previous/ current clinician.
It is totally within your right to refuse consent here, and I completely respect that choice! Please tell me know if you have any questions. Thank you.
What is a DA? Diagnostic Assessments and materials are key information for me to have, and saves us from a lengthy intake session. I am always open to skipping this aspect of therapeutic care (either a DA or Intake Session), but please note your level of care will not be as well rounded on the onset and will instead be unearthed over time.
What if I want you to write a DA for me? You can choose to have me do a new DA for you, with diagnosis included, for a flat 200$ fee. Many find this helpful. You will have access to this Assessment via PDF.
What is collaboration? Collaboration is part of offering a high level of care, which every client deserves. It is considered part of ethical practice. And essential if you'd like me to work with your other counselor(s).
Note: This form is HIPAA compliant.
Authorization for Release of Confidential Information and/or Collaboration
Enter the following information about yourself (the client).