Request for Records, Letter, or FMLA
Request for Records Policy­ Garrett Counseling 
(As stated by the State of Alabama ­ Section 12­21­6.1 Alabama Code Reproduction)

One dollar ($1) for each page of the first 25 pages ● Not more than 50 cents ($.50) for each page in excess of 25 pages ● A search fee of ten dollars ($10) ● Administrative fees ­ includes additional cost for mailing/faxing ($40.00) if needed for mailing. Our default is to email records, therefore an email is required.

Note: All summary letters for court, lawyers, school systems, work and clinical summaries for other reasons cost $150.00 per letter
Note: Anything related to court requires you complete our court policy form. You will be sent that form to complete before anything related to court is fulfilled.
Note: All email exchanges with lawyers cost a prorated cost of $150.00 per hour
Note: FMLA paper cost $50.00 each time our office completes the form

NOTE: If you need a summary of your appointments (past or future) you can print this for free from your client portal. If you need your treatment plan or diagnosis, that can be found in your portal too. Your counselor sends you a treatment plan at the start of treatment and each time they update it. If you print it from the portal yourself there is no fee. You can also get an appointment history from your portal.

You must make your request in writing with the following information. Payment must be received before records can be released. Please allow a minimum of two weeks for processing from the time payment is received. 

records@garrettcounseling.com

Sign in to Google to save your progress. Learn more
Full Name of CLIENT *
Email of Client or Guardian *
Phone Number of Client or Guardian *
Dates you were seen at our office *
Who was your counselor? What location? *
Which of the following do you need? *
Required
Who do you want the records (or letter) sent to? If you need them for court or disability you will need to have them sent directly to your lawyer.  (NOTE: You will have to complete a release of information and email it to us directly with this persons name listed).  NAME of person


 *
Company of person to release records (or letter or FMLA paperwork) to. *
Email for who you wants records (or letter or FMLA paperwork) sent directly to. *
CONFIRMING - What do you need sent? Check ALL that apply. IF you check them all you will be charged for each of them. Be sure of what you are needing before requesting. If you are not sure, talk with your lawyer or counselor about why you are needing records so they can help guide you.  *
Required
Is there anything specific you are needing this for? For example, FMLA (to be off set hours to attend appts, or bring your child), Letter for court (what are you needing it to say), summary of your treatment (anything specific?). *
If there are divorce papers or there are current lawyers involved please let us know your lawyers name and that you have a release on file already.  *
By typing my name in, I am confirming I am this person or that I am the guardian of this client and I have legal rights to request these documents.  *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Garrett Counseling.

Does this form look suspicious? Report

Google Forms