Release of Information Form

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Release of Information Form

Richard Lam, LMFT 104406
Feeling Good Institute
2660 Solace Place, Suite D2, Mountain View, CA 94040
richard@feelinggoodinstitute.com
650-567-6496

Please fill out this form for any person whom you would like us to notify of your treatment and consult as needed. Common uses of this form are to authorize communication with a current or recent mental health provider, a medical doctor, a parent, or a support person. You may fill out multiple versions of this form by completing one time, closing, then re--opening the form a second time.

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