Releases, Notices & Documents
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Please click LIMITS TO CONFIDENTIALITY (New Client + TELEMED) button, above to sign and submit authorizations required to conduct evaluation. (Includes Telemedicine Release)
Please click LIMITS TO CONFIDENTIALITY, New Client (NO TELEMED) button, above to sign and submit authorizations required to conduct evaluation. (Does not include Telemedicine Release)
Please click LIMITS TO CONFIDENTIALITY (Existing Client) button, above to sign and submit authorizations required to conduct evaluation. (Includes Telemedicine Release)
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Please click BWC Initial Therapy Client Releases button, above to sign and submit authorizations required to begin treatment of workers injured in Ohio. (Includes Telemedicine Release)
Please click Telemedicine Release button, above to sign and submit authorization.
[REQUIRED to receive telemedicince services: phone and/or virtual (video+audio)] Please click Consent Form - AI button, above to sign and submit authorization form.
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| Telemedicine Release |
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