RECORDS REQUEST

If you are needing a copy of your records, complete the form below. Please note that if you are not the client, you will need the client's authorization to acquire records through the client's provision of a Release of Information form. If there is not a Release of Information form on file, then the client will need to provide authorization by completing a Release of Information form for your records request to be fulfilled.

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1. Complete the Release of Information form.

2. Send the completed form, signed and dated, with selected instructions on information to share and to whom:

• Option 1: Mail to:   Records Request
                                    Trauma Informed Counseling Center
                                    713 Millpond Rd., Ste B-3
                                    Lexington, KY 40514
   

• Option 2: Fax to:     (859) 368-0018

• Option 3: Email to:  ticcrecordsrequest@gmail.com