Release or Exchange Confidential Information Request

To request that we release copies of a medical record to another healthcare professional, please print and complete the Authorization to Release Confidential Information form and return it to us by mail or by fax.  Be sure to provide the full name and mailing address of the healthcare professional that we should send records to, and to provide your telephone number so that we may contact you if we have any questions.  After we have received your authorization, we will send you an invoice to cover our cost for the reproduction and handling of your records.  Because the cost for the reproduction of medical records is extensive, we do require payment before we send out copies of your record (as provided for under Massachusetts State Law).

 

Please note that we generally are able to provide complete evaluation and treatment records only to qualified, licensed mental health professionals, not directly to patients or their family members.

   

To give us permission to exchange information (for example, to discuss you or your child's treatment by telephone with another healthcare professional or a teacher, etc.), please print and complete the Exchange Information Request form and return it to us by mail or by fax.