Authorizing Us to Share Your Information
Your mental health information is private. When you want Austin Concierge Therapy to communicate with another provider, attorney, school, family member, or other person or organization, we generally need your written permission.
What a Release of Information Does
Your mental health information is private. In most circumstances, Austin Concierge Therapy cannot share information about your care with another person or organization unless you authorize us to do so or disclosure is otherwise permitted or required by law.
A Release of Information (ROI) allows you to give us written permission to communicate with a specific person or organization and identifies what information we are permitted to share.
You might use a Release of Information if you would like us to communicate with:
- Another therapist, physician, psychiatrist, or healthcare provider
- An attorney or other professional
- A school or educational institution
- A family member, partner, or other person involved in your care
- Another organization you specifically authorize
Complete a Release Online
Current clients can complete a Release of Information electronically through the SimplePractice Client Portal.
The digital Release of Information must first be sent to your portal by our office. Contact us and ask us to send you a Release of Information form. Once it has been sent, you will be able to find and complete it in the Documents section of your Client Portal.
If you have already requested a release and do not see the form in your portal, please contact us. We can help you locate it or send it again.
What You Will Need to Provide
A valid authorization generally identifies the information you are giving us permission to disclose and the person or organization permitted to receive it.
Your Release of Information may ask for information such as:
- Your full name and identifying information
- The person or organization authorized to receive information
- Contact information for the recipient
- The information or records you authorize us to disclose
- The purpose of the disclosure, when applicable
- Any limitations you would like placed on the authorization
- When the authorization expires
- Your signature and the date
Please provide complete and accurate contact information for the person or organization receiving the information. Missing information may delay our ability to process your request.
What Information Will Be Shared?
We will disclose information only as permitted by your authorization and applicable law.
You may authorize broad communication or limit the release to particular information, records, dates, or purposes. If you would like the authorization limited in a specific way, please make those instructions clear on the form.
Completing a Release of Information does not require us to disclose information beyond the scope of your authorization or information that cannot lawfully be released.
Changing or Revoking an Authorization
You may generally revoke a Release of Information by notifying Austin Concierge Therapy in writing.
A revocation applies going forward. It does not undo disclosures that were already made in reliance on a valid authorization before we received your revocation.
If you would like to change who we may communicate with, what may be shared, or the scope of an existing authorization, contact our office. We may ask you to complete a new Release of Information form.
Questions or Assistance
If you are unsure whether you need a Release of Information, need us to send the digital form to your Client Portal, or need help returning a completed PDF securely, please contact our office.
You do not need to determine the correct form or process before reaching out. Tell us what you are trying to accomplish, and we will help you with the next step.
Download a Release Form (PDF).
So you can print, sign, scan, and send.
If you prefer, you may also download and complete our Release of Information form as a PDF.
The downloadable PDF must be completed and signed outside of SimplePractice. Once completed, please return it to our office using a secure method.
If you are unsure how to return a completed form securely, contact us before sending it and we will provide instructions.
You don’t have to figure out the paperwork alone.
If you’re not sure which form to use, how to complete it, or how to return it securely, Cass can help you get started.
For current clients, she can also arrange for a digital Release of Information form to be sent to your SimplePractice Client Portal. Once it’s there, you can complete and submit it electronically.
If you’re using the downloadable PDF, she can help with instructions for returning it securely or make sure your request gets to the right person in our office.
You don’t need to know exactly what kind of release you need before reaching out. Tell us who you want us to communicate with and what you’re trying to accomplish, and we’ll help you find the next step.