Authorization for Release of Information (ROI) Form

Directions for Use

  • This Authorization for Release of Information form need only be printed out, completed, and brought with you if you wish me to have contact with another professional (e.g., psychiatrist, teacher, previous therapist, neuropsychologist, etc.).
  • Prior to printing, you may use this viewing tool and the scroll bar it provides in order to read through the document in its entirety.
  • To print the document, download it to your computer. Select the “Download Now” link in blue, below. This will move the document from my server to your computer.

Download Authorization for Release of Information