Authorization For Release Of Information

The MCPST Authorization For Release of Information Form authorizes release of information to and from another person, for example your psychiatrist or former therapist, for your benefit, i.e. in order to coordinate services for you.

You may download a printable copy of the MCPST Authorization for Release of Information form.

Please visit our MCPST Forms page for information about how to use this form.

Top of page

Midwest Center for Psychotherapy & Sex Therapy · 6300 University Avenue, Suite 125 · Middleton, WI 53562 · (P) 608-237-8000 · (F) 608-237-8005