LWC Release of Information Form

Please complete this form in full. Individuals over the age of 18 must authorize the release of their own information. A fee may be required for records release and must be paid prior to the release of information. 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 to a records request within 24 hours (during regular business hours M-F) or have any questions or concerns, please contact us for assistance. A minimum of 10 business days must be provided to process requests (14 days for third-party requests).