HIPAA Authorization Form


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If you are requested to provide any confidential health records to a third party, you must have your client sign this form, and you must specifically describe in the form what information you are providing, to whom you are providing it, and for what purpose it has been requested. If you are the one requesting use of the confidential health records, you must provide a copy of this form to your client.

There is specific language required to be included in this form, and this specific language is in the form provided to you here. You may add additional elements to the form, so long as they do not contradict the required language. We recommend that you use the form exactly as it is provided for you here.

This form is also a part of the INTAKE AND HIPAA FORMS set. If you’re buying multiple forms save money by buying them together!

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About Therapist 2 Go

At Therapist 2 Go we create organization and information management tools for psychotherapists that are straightforward and easy to use. We believe that forms do not have to be complicated to be functional and efficient and to capture the client information that you need to provide effective therapeutic treatment. Our goal is to help you run an efficient, profitable business, allowing you to spend more time focused on the therapeutic process and less time on routine administrative tasks.