---
title: PHI from Mental Health Provider
description: Michigan Legal Copy Forms for the release of protected health information from a Michigan area provider of mental health services.
---

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# Forms for Record Request Form & General Authorizations

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### Authorization For the Release and Disclosure of Psychotherapy Notes

Click the button below to access the form

[![View Form](https://no-cache.hubspot.com/cta/default/5105050/interactive-196600086949.png) ](https://www.mlcopy.com/hs/cta/wi/redirect?encryptedPayload=AVxigLI%2FeK9qdGKrVuMlZ5MOdzvKT2YYv3%2B9dUSrUyFfF6mU7BKUenTlqsuRl8NyKdw6ZH%2Faycn8DIx3KbgAu9LsA1P6B0c9KXPOLBD0Iw8e38Z%2F%2FlyBQgU0XEAmbZZw%2BzfG%2F7o3Q4tM18ioI4U7B2U%2BdWBbEkXbrTOGv771eZCIFJ8%2BtCIL1QPRYd%2BNjEAhv4ius9M7y9T6wvD%2FxCYBh8fQUi3wdSiZ6ma1dgQqehN%2FEm1MBiQwkdYl3RXHz3KCbWDo4FF44By%2B3n%2BtRnLMk5HOmBBq40lNKC%2Ff1wcxHUjZ7Xe9Kv2a%2FmpyomB3&webInteractiveContentId=196600086949&portalId=5105050)

**

### FERPA Release- Education Records

Click the button below to access the form

[![View Form](https://no-cache.hubspot.com/cta/default/5105050/interactive-196600188853.png) ](https://www.mlcopy.com/hs/cta/wi/redirect?encryptedPayload=AVxigLJMs4Z6Q2NXx05tOjBkYU0cxCh19mSqRr5AHxAX7wso7VQlYoklvP62grP4rU6y5tqxS9aPhQpTvuCsVYFJlF6Iu6r4G50dJ9ggtwLetbbeOYkCfgbMr2OmHaoMMeWiJZOPLfP7lPje0KWYIkcnb0a96bRC2UrtN0AvE04J%2F7ZEuAmYVygiDxa5tLS8f7QGjctkPzFIxhkXJ9JCstgQpnSTh0bOD1W0qWUIl94cHkufwHzh1SRuCOPsLjahGktnfisz6KBuDAfqRFpCRN93CaBiLkYGfHwO78%2FfIbzEhkopyKtwxlQXFLgI&webInteractiveContentId=196600188853&portalId=5105050)

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### General Education Authorization Form

Click the button below to access the form

[![View Form](https://no-cache.hubspot.com/cta/default/5105050/interactive-196600086968.png) ](https://www.mlcopy.com/hs/cta/wi/redirect?encryptedPayload=AVxigLJbnnNmb%2BUq%2FgiQMYFSDppQ0WjNi9BPj6YrJssHsbEYBct8HBBwgV%2FEJj2aNtNXjBFs9ITtMTsdL%2FLz1PRa4yKMdrLHL8quD8pX%2FrvDXQ4mfNkM3EIU6k4%2Bgd1fbOUiXxcTlAL5l20MLJKHtHButlLcsj3r67aP1wkGuVn7q1NG9cd04c1uonjxEPGlUGkfMqIGkkTlos9vDSqamxKp9LpxD39eFfTFxA9pLSYvsg03uCug5XfcUdA3S3eJhRuJJ4MMfcv050%2FMwVxg8S2jvvTVDg%2FKrflQoEUeykkzsW1WniGfWIrxB9Fb&webInteractiveContentId=196600086968&portalId=5105050)

**

### General Employment Authorization Form

Click the button below to access the form

[![View Form](https://no-cache.hubspot.com/cta/default/5105050/interactive-196600087045.png) ](https://www.mlcopy.com/hs/cta/wi/redirect?encryptedPayload=AVxigLJn5di66juCZBQbzAZzRLfuZlHpyoaQNnIMR1eZnXSukl1TaQJTxbWQsRPbF%2BBTEJda8yFYe9vVzmp1iYPIzsi403GzScvyQ6xR%2BYUOiOe1rYZq57SY279ZSAffpc65qXqMgc%2BASFpzN51UpoHjFvscC0wusZonS85bmTQ9LkfJbGBD%2BRncWo3inTFdnCqj%2Fm1t1b3SaaginQkCSAAE83zZcZ4rD7981TLgIK34p2Uh3cNktYWb51zZh6cd%2FpDV%2B8U388jCFl0veSNM9Hmpb7eZqtexYpZsOZ7l9PHsS0N%2FtPwYnktfXcBv&webInteractiveContentId=196600087045&portalId=5105050)

**

### General Insurance Authorization Form

Click the button below to access the form

[![View Form](https://no-cache.hubspot.com/cta/default/5105050/interactive-196600188948.png) ](https://www.mlcopy.com/hs/cta/wi/redirect?encryptedPayload=AVxigLIEBOeMkl3Tbnd1LQYqd%2FWQN%2B7TAxS1AmVIEocb%2BDO7dcscmnIMBoFS3etUKrmIx66iJRNQLGXiJFCo4ANk2g9p2OC1rlrxs5YwF%2BwMezI9IqOUbRjE4XyL6lFFqNneR7BJeRnVmzIa2J%2FhC5LTbJhS7wESNAvVQF1bi64Id87Ct3clIyj1kyDVI4eqKiUdWrpbMD0TRcsZlkCZR4Dy%2FEiZm9aJjlvEcf%2FCx0m9B2I0su6pTP71SKGMEQHIe7nmR0hC59BdrZOGaOqs3sXAeBbwkK2qnU%2FQtqBUrzHrXSxMdRWoiT16NjS4&webInteractiveContentId=196600188948&portalId=5105050)

**

### General Insurance- PIP Authorization Form

Click the button below to access the form

[![View Form](https://no-cache.hubspot.com/cta/default/5105050/interactive-196600087061.png) ](https://www.mlcopy.com/hs/cta/wi/redirect?encryptedPayload=AVxigLJhYVkKVirnGvDVMa9uVVA7XWp6n0BqotOg4i%2B4asfeJeNgwIK8WtnHQn8QTBsP5RQMu9xlPKYwKsP0BLyhKWWjt2n9jBk6t95S7j0Cdzqzj2uCSOtDvohZ5W%2BCgc%2FMjNKia2VS72Xya691XzUUktE0KbHJQK20D4YtwZj%2FdZge%2B%2BJC6HOzmoMVqeCkgBCkPAAhtV%2FcrA5LJvyFtP9PIyvC9h7ecexMh3EBj%2FAJoe9kjjZkWIKTorayi9QvSsDv3Z1EqNsPfdMKP16QKJzFiRmb%2BypQuBXnBBTebYtHHNIg%2BI1BFllZHKb2&webInteractiveContentId=196600087061&portalId=5105050)

**

### General Medical Authorization Form - No Language

Click the button below to access the form

[![View Form](https://no-cache.hubspot.com/cta/default/5105050/interactive-196600188978.png) ](https://www.mlcopy.com/hs/cta/wi/redirect?encryptedPayload=AVxigLLrQwVU1u%2BqEJtrnCIRbZSvr5ZUEJaloOy2UkZYW1lln9UHXL%2FedBxRlZk9bGYPzi35v56lkqt0axvWaoBgBpHQlDJmYBwedgdOZzoo6cCgAt%2Fe8TDCZx79DrKWZ5AqOztaEap6fRwqazmCQdegrTAoCNzopXIOGn4ptPgBYyM8WODKFXeWlKMpAQZ3YzBUEMZDejwldihOyU3r3v8Ex46I5LzZjgOeTo8RxygkSVjsaEfs%2Bdy%2FXqqXsD6oXruRkXV7BKlubwNp4n63DXujI6bnGFW7RyFXsa9hAjp%2B2LCN%2F6%2BVOtnGKkUC&webInteractiveContentId=196600188978&portalId=5105050)

**

### General Medical Authorization Form- With Language

Click the button below to access the form

[![View Form](https://no-cache.hubspot.com/cta/default/5105050/interactive-196600188983.png) ](https://www.mlcopy.com/hs/cta/wi/redirect?encryptedPayload=AVxigLLEwH1ebLpRTzELtoRN9FTR03M4nfzxiPUU7FTUYW7tUIlVfTCj%2FN%2FdbVTrlNOlXolVw3lguS7w%2BKF8mNYKxiPzLaMbQfz7l8v6UBWqjSEl6ukAIC3t5gY6k9iL8krL2Qa4ksyDNAcwYSZx%2BZ%2BN73wakjtbMmZKBUHVwkp6Z9cvOQzjzRBLt9pvQJzkVrwjSyHarEUNvdrupgWck4GsuAtb4xr8xaDh14rD08fhDEwDuJTpXv5XYC8Ym0HzymBn6I3Px%2BpVYRvZgWkTnsou0%2F6%2FxBbq1vsrGchst2lvZONhlLu%2BSXwZWVsAGvWqwV6%2F3gPXpZdfN4MWZ3UW6do79lRJvoRn26Eh3uFPHhrC%2BdF8CW4bzk4hv9NM6KtvFVlJj7QmRQrFR1Z9pH4%2BXKgey%2BKbsgW4epbZkmKjRltDV1xTu8OHGB3taor7RCTWXE%2FpzCk2505%2Fyb6rOjBLZhERMvQZ%2BwP%2BU8yvIp%2BLEHTUEIs%3D&webInteractiveContentId=196600188983&portalId=5105050)

**

### Record Request Form

Click the button below to access the form

[![View Form](https://no-cache.hubspot.com/cta/default/5105050/interactive-196600087073.png) ](https://www.mlcopy.com/hs/cta/wi/redirect?encryptedPayload=AVxigLKc1xNwz%2FQwEYbODDOws7GaAKOTDSvnSJpMjc7LUo9ZjRLumZCRLgvoHIV7nwC%2BR6XLsbNOVxS5YBpReAtV2CsVAz6dnhFeAeKAvmucBE2EZZgVRnckKgloFkpNnzEMFYC%2F5eLG%2BgZUiYdcD6aYRCKWW7rm0V5MesIyPN2RqlaJATCLp0eXcbnYEl4wUEEAuuCvSONjRjyKlhT734%2BjSz%2FSB7pH1%2B3%2F%2BQy0w%2Fp3wVD49n%2BM4s5Bkt6EWo7qVGCkGI6AFzPNsVnExMslzNsVcwXcDfWZq0ZIIZ0QgKy%2FHZtPT3I%2FOUcdo%2BLo&webInteractiveContentId=196600087073&portalId=5105050)

## Start Your Record Request Today!

All records we receive are checked for accuracy and distributed within 24 hours of receipt via a secure online repository.

[![GET STARTED](https://no-cache.hubspot.com/cta/default/5105050/7132e73d-40ae-46d7-8463-e952b917b3f2.png)](https://cta-redirect.hubspot.com/cta/redirect/5105050/7132e73d-40ae-46d7-8463-e952b917b3f2)

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