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Forms

Digital Signature and Submission Instructions

  1. Download the correct file and save the blank form to your computer.
  2. Open the saved file in Adobe on your computer and complete the form.
  3. Click on the signature icon (pen) on the menu section and create/drag your signature to the signature line.
  4. In the absence of a witness signature, you need to speak with a CPS clinician to verify your identity and request for release of information.
  5. Save the completed form and email it as an attachment to 7405930091@fax.ohio.edu.
  6. For security reasons, we encourage you delete the saved copy from your computer once you have received confirmation of receipt from CPS.

Release of Information Forms

The Release of Information Forms grant legal permission for Counseling & Psychological Services (CPS) to share protected health information with another person or agency.