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Release of Information

The Release of Information (ROI) authorizes a provider to share protected personal and health information with a designated recipient. Complete this form if you wish to do any of the following:


  • Retrieve past personal or medical information from past providers and/or facilities to transfer to Evolve Psychiatry

  • Request copies of records to be sent from our clinic to outside providers and/or facilities

  • Allow Evolve Psychiatry staff to involve your loved ones in your care

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