Release of Mental Health Information form - University Health Center 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your personal information in the designated fields, including your name, date of birth, and contact details. This ensures that the University Health Center can accurately identify you.
3. In the 'Second Party' section, provide the name and address of the individual or organization that will receive your mental health information. Ensure all details are correct to avoid any delays.
4. Specify the type of mental health information you wish to disclose by checking the appropriate boxes. Options may include counseling records, psychiatric evaluations, or other relevant documents.
5. Indicate the purpose of disclosure by selecting from options such as consultation or personal use. This helps clarify why you are sharing this sensitive information.
6. Finally, sign and date the form at the bottom. Make sure to read through all sections carefully before submitting to ensure everything is accurate and complete.

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