If Dr. Smith has asked you to complete these forms, please attach and submit them here →
Release of Information
Release of Information - If you would like me to speak to another person regarding your case this form must be completed and signed. People with whom you would like me to speak may include anyone ranging from another treatment provider, to an attorney, to a close family member. Should I be contacted by someone regarding your case for whom I do not have this authorization, my commitment to confidentiality remains completely in tact and I will not even acknowledge whether or not you are in treatment with me.