Medical Release Form

Rygiel's Renaissance requires completion of a medical release form from clients in order to:

• Diagnose their medical/psychiatric/psychological condition
• Plan individual care and treatment
• Communicate with other health professionals concerning a patient's care
• Document services for payment/reimbursement
• Conduct routine health care operations

Please download and complete in advance of your visit a copy of the Medical Release form contained on this page. Two versions of the same form are available: one in Microsoft Word and the other in Adobe PDF.

Thank you.

Adobe PDF Version
MicroSoft Word Version