1. Electronic Records Consent: Additional consent for the electronic transmission of information, used when records may be shared digitally

2. Third Party Authorization: Section for authorizing release to multiple parties, used when information needs to be shared with multiple recipients

3. Minor Client Information: Additional section for parent/guardian details and consent, used when the client is under 18 or lacks capacity to consent

4. Specific Exclusions: Section detailing any specific information that should NOT be released, used when client wants to restrict certain information

5. Emergency Contact Release: Special authorization for release of information in emergency situations, used when emergency contacts need to be included

6. Medicare/Insurance Information: Section for healthcare identifier numbers and insurance details, used when information sharing involves healthcare providers or insurance companies

1. Schedule A - Types of Information: Detailed checklist of specific types of psychological information that may be released (e.g., assessment results, session notes, diagnostic information)

2. Schedule B - Approved Recipients List: Comprehensive list of all approved recipients and their contact details, used when multiple parties are involved

3. Schedule C - Privacy Notice: Detailed privacy notice explaining how the information will be handled and protected by recipients

4. Appendix 1 - Glossary: Definitions of technical terms used in the form to ensure client understanding

5. Appendix 2 - Revocation Form: Template form for revoking consent if the client chooses to do so in the future