McBurney Authorization for Release of Confidential Information Form

Download McBurney Authorization for Release of Confidential Information Form

The McBurney Center's Authorization for Release of Confidential Information Form is a Word document that can be filled out by the student and submitted to the McBurney Center to obtain copies of records for self, allow a the McBurney Center to request copies of records from a clinician, allow service providers to communicate with McBurney Center staff, and other legitimate records release uses.