Information Release Form Template

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Video & audio overview of the template

What is the theory behind the template?

Working in a multidisciplinary team or gathering information from other health practitioners, teachers, etc. can benefit your treatment plan. However, this information can only be gathered/released with express permission from your client.

This template may be part of your contract, however, you may decide to keep it aside and only use it when necessary.

How will the template help?

This template guides you and your client on gathering/releasing information to other individuals. This template ensures that all parties are protected and allows the client to revoke the permission at any time.

How to use the template.

You can use this template when you need to gather information from another party, or when you have been requested to share information with another party.

Important to note: This is a template and as such is a general guide, it will need to be tailored to your specific practice and legal requirements.

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Oregon Psychological Association. (2023). Release of Information Forms and Information.