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.

*This form can be filled out on your computer if you prefer. Be sure to download and save the form to your computer first or you will lose what you typed. Click the down arrow to download the form and open it with your computer’s PDF viewer (such as Adobe Reader) – NOT your internet browser. Fill out the form, save the file and print it to sign and return to us.

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