Release of Information

Click here to view the view or print the Release of Information.

Please note that any faxed releases must be accompanied by an official form of identification with a signature (such as a driver's license) as well as a phone number where we may reach you.

Requests for Release of Records

  • To Self: If you want to review or obtain a copy of your records, you must schedule an appointment with your clinician. During that appointment you will have the opportunity to ask questions while you read the chart. In addition, if you see something that you would like clarified, you may write it on a separate sheet of paper which will then become a permanent part of your record. After you sign the SCC release of information, you would be provided with a copy of your records.
  • To Others: Some clients (or former clients) want their records released directly to a third party, such as another mental health provider or a law enforcement official. In those cases, you must first sign a release of information specifying exactly what information you want released and to whom (and contact information for that person). A signature on a third party's release of information form is not sufficient.  If you want your records released to a law enforcement official or an attorney, you must also confirm your request verbally to an SCC clinician (by phone or in person). When records are released directly to a third party, you are not required to schedule an appointment with the clinician to review them yourself.

If you have any questions concerning the UM Student Counseling Center’s policies and practices concerning confidentiality please do not hesitate to call the Director, Emilia K. Petrillo, LCSW-C at 410-328-8404.