Client Rights & Forms
Release of Information Authorization
Last Updated · June 16, 2026
A Release of Information (ROI) lets us send a copy of your records to another provider, family member, attorney, or organization you designate.
To Request
- Complete and sign the ROI form (request at your visit or by email).
- Identify the recipient, scope, and time period of records.
- Authorizations may be revoked in writing at any time.
This document is provided as a draft for informational purposes and is pending final review by qualified healthcare counsel prior to publication to ensure compliance with applicable federal, Florida, HIPAA, telehealth, wellness, and healthcare regulations.