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AUTHORIZATION TO RELEASE/EXCHANGE INFORMATION, (hereinafter Client) hereby authorize Gray Consulting and Therapy, LLC, Provider) to disclose/evaluation and therapy information and records obtained
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i hereinafter client hereby refers to the specific document or form that needs to be filled out and submitted by the client.
The client, as indicated in the document or form, is required to file i hereinafter client hereby.
To fill out i hereinafter client hereby, the client must provide the requested information accurately and completely as per the instructions provided on the form.
The purpose of i hereinafter client hereby is to collect specific information from the client for a particular purpose, such as compliance or record-keeping.
The specific information that must be reported on i hereinafter client hereby will be outlined in the form itself, and may vary depending on the purpose of the form.
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