Release of Information
Click the link below to complete a fillable Release of Information (ROI) as needed. This can be printed and given to your provider or LCBH front office staff:
English ROI
Spanish ROI
| Attachment | Size |
|---|---|
 LCBH Release of Information (Spanish) - Fillable.pdf | 334.04 KB |
| LCBH Release of Information (English) - fillable.pdf | 534.76 KB |