Forms
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For Consumers

Client Demographic Form

Release of Information Form*

Client Rights and Responsibilities and Privacy Practices Notice

For Professionals

Release of Information Form


*Completed authorization forms may be mailed or faxed. There are fees for copying records. First 25 copies ($1.00 per page), 25 cents for each page thereafter. This is the cost of producing copies as per Florida law.

If you would like to speak to someone in the Clinical Records Department about your request, please call (239) 275-3222.

Mailing address:
Lee Mental Health Center
2789 Ortiz Ave.
Fort Myers, FL 33905