Get Clear Consent to Share Behavioral Health Information

The Behavioral Health Coordinated Care & Treatment Information Sharing Consent Form gives clients a clear, structured way to authorize the exchange of their behavioral health information between providers and others involved in their care. The client, or a parent, guardian, or personal representative, names the provider or program authorized to share information, the direction of sharing, and each authorized recipient's contact details. The form also records which types of treatment information may be disclosed, which specially protected information the client chooses to include, any information that must not be shared, and the purpose of each disclosure.

This template is built for mental health clinics, substance use treatment programs, integrated care teams, community health centers, care coordinators, and private practitioners who need documented permission before communicating with primary care doctors, schools, family members, case managers, or other agencies. The form explains consent rights, revocation, and expiration in plain language, so clients understand what they are agreeing to and can make informed choices about their privacy.

An online consent form replaces paper releases that are easy to misplace or fill out incompletely. Structured fields and select-all-that-apply options help ensure every authorization includes recipients, information types, purpose, duration, and an expiration date when needed. Customize the wording to match your policies and applicable regulations, share the form by link or embed it on your website, and keep every completed consent organized and easy to retrieve when coordinating care.