You may obtain copies of your treatment records or a program attendance letter for your own use or have records sent elsewhere, but only at your written request. 

You must complete a Consent to Release Confidential Information form and return it to us with your original signature.    

1. Open and print the Consent to Release Confidential Information Form.
2. Complete and sign the release form. Please note: The signature on the release must match the original signature in your medical record.
3. Mail or fax the form with your original signature to 573.442.3830.

For more information contact Merritt Mosely at 573.875.8880 Monday through Friday, 8:00AM to 5:00PM or by email.