SOAR – Seeing Our Adolescents Rise, Corp needs to be sure we have your consent for different items, in order to ensure your child’s safety while in our care.  Please read the following carefully and ask your staff for more information as needed.

I understand that I have the right to request that SOAR restrict how it uses and discloses my child’s Protected Health Information in order to carry out Treatment.  I understand that SOAR is not required to agree to the restrictions, but that if SOAR agrees, the restriction is binding.

I agree to allow SOAR staff to make referrals on the behalf of me or my family to organizations/service providers/employers discussing meetings or by phone.  I understand no referral will be made without my prior knowledge.