Release of Information Forms for Dr. Michael Golden, Dr. Douglas Dicharry, and Dr. Alina Schneider can be found below our general release of information.  

Release of Information
It is important for our providers to be able to coordinate patient care with a primary care doctor, a therapist and/or your child's school.
Download the fillable form, save it to your desktop, and then open the form and complete. You may also print the form and complete it manually.
Authorization to Release PHI - 2017 fill[...]
Adobe Acrobat document [314.6 KB]
Release of Information for Dr. Luke Brewton
Download the fillable form, save it to your desktop, and then open the form and complete. You may also print the form and complete it manually.
Auth to Release PHI 2017 - BREWTON filla[...]
Adobe Acrobat document [64.7 KB]
Release of Information for Dr. Michael Golden
Auth to Release PHI 2014 - GOLDEN.pdf
Adobe Acrobat document [68.5 KB]
Release of Information for Dr. Douglas Dicharry
Auth to Release PHI 2014 - DICHARRY.pdf
Adobe Acrobat document [119.7 KB]
Release of Information for Dr. Alina Schneider
Download the fillable form, save it to your desktop, and then open the form and complete. You may also print the form and complete it manually.
Auth to Release PHI 2015 - SCHNEIDER fi[...]
Adobe Acrobat document [109.9 KB]