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An adult client may use this form to authorize Jason to release or obtain protected health information. It can be returned in person, by mail or by fax.
A parent or guardian of a minor client may use this form to authorize Jason to release or obtain the minor client’s protected health information. It can be returned in person, by mail or by fax.
There are times when a person other than the client is paying for my services. This form discusses important items related to fees, confidentiality, and the termination of the agreement. It also serves as the contract between the person paying for services and Athens Professional Counseling Services, LLC. The person paying for services completes and returns this form to Jason.