Release of Information 


A release form detailing client’s permission for you to consult with specific practitioners involved in your their care.

For those of us who receive referrals from doctors and psychiatrists, or would like to make referrals and maintain continuity of care, a Release of Information form demonstrates a client’s informed consent for us to consult with another practitioner.

Our form is clear with checkboxes and explanations. It contains separate sections for:

  • Client Details
  • Practitioner/Programme Details
  • Methods of Communication
  • Requesting Information
  • Sharing Information
  • Client Statement


We have included TWO correspondence templates for use with this form.

1. Referral Acknowledgement

This letter acknowledges a referral and includes the Release of Information, showing that you have obtained permission from the client to consult.

2. Referral Letter

This is an introductory letter sending a referral to a practitioner for assessment and requesting their reports.


This document is

  • Includes two correspondence wordings 
  • Reviewed by lawyers 2020
  • Format updated September 2021

This document is not

  • Is not required to break confidentiality in an emergency

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