LWC Records Release Request Form

Please complete this form in full to request a release of information or to obtain a copy of client mental health records. Individuals over the age of 18 must authorize the release of their own information. A fee may be required for records release. The fee may be paid by cash or credit card and must be paid in person or by phone prior to processing client’s records request. Please Note: Per Lake Worth Counseling Policy & Procedures, LWC does not release client progress notes and is able to provide a professional summary report only.

If you do not receive a reply for records request within 24 hours (during regular business hours M-F) or have any questions or concerns, please contact us for assistance.