Get I, The Undersigned ( Client ), Hereby Authorize Compsych Corporation S Privacy Official To

This guide provides clear instructions on how to fill out the authorization form required to allow ComPsych Corporation's Privacy Official to release information from your clinical record. Follow these steps to ensure your form is completed accurately and efficiently.

Follow the steps to successfully complete your authorization form

1. Click ‘Get Form’ button to obtain the authorization form and open it for editing.
2. In the first section of the form, enter the name of the individual or entity who will receive the information.
3. Below the name, fill in the address of the individual or entity receiving the information.
4. In the specified options, check off the type of information you are authorizing to be disclosed.
5. If you select 'Other', provide a detailed description of the specific records and/or other information to be disclosed.
6. Sign and date the authorization form at the designated areas.
7. In the bottom section of the form, print your name, date of birth, and address.
8. Once the form is completed, you can save your changes, download, print, or share the form as needed.

Complete your authorization form online today to ensure timely processing of your request.