Authorization for release and disclosure, and/or request for medical information and records – MICHIGAN
Outpatient Release of Information Form
If you are a Pine Rest INPATIENT or PARTIAL HOSPITALIZATION patient, please use the Release of Information form for Michigan.
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Accredited by The Joint Commission. Accredited by the Commission on Accreditation of Rehabilitation Facilities.
Associate Member of the National Network of Depression Centers
©2019, Pine Rest Christian Mental Health Services