SOAR – Seeing Our Adolescents Rise, Corp (“SOAR”) needs to be sure we have your consent for different items, in order to ensure you and your family members' 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 and family members' 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.