Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the form and open it in your editing platform.
2. Start by entering the client or student’s full name and date of birth in the provided fields. Ensure that these details are accurate, as they are critical for identification.
3. Next, fill in the street address, city, state, and ZIP code of the client or student. This information helps locate the individual’s records associated with ABA Therapy Solutions.
4. Review the voluntary nature of the release as described in the form. It is important to understand that your personally identifiable information (PII) is protected under applicable privacy regulations.
5. In the section where you authorize ABA Therapy Solutions to exchange, release, or obtain information, check all applicable boxes. This indicates who you want to share information with.
6. Choose the method of information sharing by selecting whether the information will be exchanged verbally, in written form, or both.
7. In the description section, specify the types of information to be exchanged, such as education records, medical records, etc. Select all that apply to ensure clarity.
8. Determine the duration of the release by selecting either a two-year period or specifying a start and end date. Ensure that you check the appropriate box.
9. Clearly state the purpose of the information release in the designated area. This helps to clarify the need for sharing the information.
10. Finally, sign and date the form. If you are a legally authorized representative, print your name along with your relationship to the client or student.
11. After filling out the form, review all entries for accuracy. You can then save your changes, download, print, or share the form as needed.

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