Get the free Release of information 07.15.10 - The Costello Center
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The Costello Center 8081 38th Ave N., St. Petersburg, FL 33710 Phone: 7273452667 Fax: 7272092667 www.thecostellocenter.com CONSENT FOR THE RELEASE OF CONFIDENTIAL INFORMATION Client Name (Please Print):
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How to fill out release of information 071510
How to fill out release of information 071510:
01
Start by entering the full name and contact information of the individual or organization releasing the information at the top of the form.
02
Next, enter the name and contact information of the recipient who will be receiving the information.
03
Specify the type of information being released and the purpose for releasing it.
04
Indicate the date range for which the information should be released.
05
Include any specific details or instructions regarding the release of the information.
06
Sign and date the form, indicating your consent to release the specified information.
07
Finally, make a copy of the completed form for your records.
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