517-788-4605
Consent and Release Forms
In order to receive services beyond Crisis Intervention from Dóchas II, we need signed Consent Forms.
If there is someone who you would like us to speak to or coordinate with on behalf of our client, we need written Release of Information (ROI) in order to speak with them.
Each of these links take you to the appropriate form to be filled out. Once completed and submitted, the page will refresh, so if you find that you have multiple forms that need to be completed, you can continue with the next form at that time.
Each form is valid for 1 year at date of signing.
If you are over the age of 18, you are your own parent/guardian and can fill out the form accordingly.
1
Please read over the consent form carefully as it goes over Dóchas II's services, policies, and requirements of the program. There will be 3 signatures to be completed. The first is confirmation that you have read and understand what you are consenting to. The second is the actual consent to work with Dóchas. And the third is optional - it is permission for transportation.
2
Please read over the Release carefully so that you give the appropriate permission. This release tells us not only who we are allowed to speak to, but what information can be shared for what purpose.
You can speak with your caseworker on the recommended ROIs to be completed, and the screen will refresh with each completed release, so you won't have to re-click the link.
3
If you have completed an ROI but do not wish to give permission for your caseworker to talk to that person, you can click on this link and complete the form to retract your former ROI.
If you speak with your caseworker, they will likely respect your wishes. But if you wish for additional security, you can fill out this form.