Get Consent For Disclosure Of Substance Abuse

Completing the Consent for Disclosure of Substance Abuse form online is a crucial step in managing your treatment information. This guide will provide you with detailed instructions to ensure that you fill out the form correctly and understand its components.

Follow the steps to complete your consent form accurately.

1. Click ‘Get Form’ button to access the CONSENT FOR DISCLOSURE OF SUBSTANCE ABUSE form online.
2. Fill in your name in the designated section, ensuring accuracy to match official identification.
3. Provide your date of birth (DOB) in the designated area. This is important for identifying your treatment records.
4. Indicate whether you request disclosure of information or authorize obtaining information by checking the appropriate box.
5. Specify the recipient of the disclosed information by providing their name, address, and phone number in the respective fields.
6. Initial all relevant alcohol/drug treatment records that apply to your situation. This includes the type of records you are consenting to disclose, such as attendance or assessment summaries.
7. State the purpose of the disclosure by checking the appropriate box, such as further treatment or legal request.
8. Choose the method of disclosure (verbally, in writing, and/or electronically) by checking the relevant box.
9. Review the section explaining your rights regarding consent and the expiration of this consent form. Specify the expiration condition, if any.
10. Sign and date the form at the bottom. If applicable, include signatures from a parent, guardian, or authorized individual.
11. Finally, check if a witness is required to sign and date the document.
12. Once completed, save changes, download the document, print it, or share the form as needed.

Complete your consent for disclosure form online today to ensure your treatment process is smooth and protected.