Authorization for Release of Psychotherapy Notes
This form allows you to give us permission to release psychotherapy notes (your personal therapy notes kept by your therapist) to specific individuals or organizations. Psychotherapy notes are kept separate from other medical records and have extra privacy protections under HIPAA.
Important Information
- You can refuse to sign this form without affecting your care.
- You can revoke this authorization at any time by contacting our Privacy Officer.
For more information, please contact our Privacy Officer:
Aimee Williamson
Phone: 251-725-0260
Email: info@ldchc.org