Intake and Consent Forms
*For families, couples, partners, and spouses, each client should fill out an individual intake form.
Authorization for Disclosure of Health Information
Signed Authorization for Disclosure of Health Information requests can be faxed (215-898-0509), mailed (3535 Market Street, Suite 670, Philadelphia, PA 19104), or completed in the clinic. Third party requestors must submit a valid release inclusive of service dates. There is no charge for medical records at this time.
Statement of Client's Rights
View our Penn Medicine Client Bill of Rights, available in various languages.
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