Authorizations to Release Protected Information
If requested, please download the correct form, fill in the blank fields, and return to Dr. DiCarlo by email. For court-involved clients, please do not modify any other fields on the forms, including unchecking boxes, unless requested to do so.
Authorization to Release Behavioral Health/Medical Information
Authorization to Release Academic Information
Authorization to Release Police Department Information
Authorization to Release Third Party Payer Information
Authorization for Collaborative Contact with Multiple Providers (Court-Appointed Cases)
Please use this form to allow another individual to participate in your counseling process.
Collateral Therapy Agreement
Evaluation Collateral Information Form