Directory Results for RELEASE OF INATION AND AUTHORIZATION FORM Brighter Futures Counseling, PLLC 1002 North Mulberry Street Elizabethtown, KY 42701 phone (270) 9829292 fax (270) 9829293 Client Name: Date of Birth Address: Street City State Zip Phone Number to Release of Ination and Authorization of Sharing. Release of Information and Authorization for Sharing