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. If you are a current client, a release of information can be added to your Therapy Notes client portal, ask Mimi to send to you.
Please fill out this form, including:
Please fill out this form, including:
- Name and contact information/fax number of person or organization needing information
- Limits of what type of information you want provided
- End date of this release (typically 6 months to 1 year)
| Release of Information |