email Mimi
 
 

Other Client Forms

If you need for Mimi to release information to a person or organization, please print out the linked "Release of Information" form below using Adobe Acrobat Reader.

Please fill out this form, including:

  1. Name and contact information/fax number of person or organization needing information
  2. Limits of what type of information you want provided
  3. End date of this release (typically 6 months to 1 year)

 
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