**Please specify type of information requested, including specific dates.
Please submit a request for records in writing that includes the timeframe of the records, the specific information being requested, and the names the record may be under during that timeframe to: jburnhamleavitt@blueskycounseling.com
1. Print and fill-out the release of information form completely OR complete the online form:
Printable: Authorization to Release Confidential Information
Online form: Authorization to Release Confidential Information
2. Fax to 207-614-8009 or email to jburnhamleavitt@blueskycounseling.com
To inquire about a submitted request, contact Julie at 207-616-0705 ext.1502
**There may be a charge for records.**
