Medical Records

Twin Cities Therapy and Counseling is committed to client privacy and confidentiality. Client medical records are protected by federal law. We will not share medical records or information without valid written authorization from the client, except in limited circumstances (see Notice of Privacy Practices for exceptions).

Clients may:

  • Request a copy of their own medical records and/or billing records
  • Request a copy of their medical records and/or billing records be shared with someone else
  • Authorize us to communicate with someone else about their health care and/or billing matters

Clients Requests

  • To request a copy of your own records, complete:
    Record and Information Request Form
 
  • To request a copy of your medical records be sent to someone else, complete:
    Record and Information Request Form AND
    Release of Information (FILLABLE ROI)
 
  • To authorize us to communicate with someone else about your health care and/or billing, complete:
    Release of Information (Fillable ROI).
 

All documents are available for completion within your Client Portal.

Click Here to Access

Third-Party Requests

  • To request a copy of client medical or billing records, complete and submit:
    Record Request Form AND
    Authorization Form     completed by the client

  • To request that we communicate with you about client medical or billing information, submit:
    Authorization Form completed by the client.
 

Both forms are available for download below and may be submitted by secure fax, email, or mail:

Twin Cities Therapy and Counseling Associates
4025 West Broadway Avenue
Robbinsdale, Minnesota 55422
Fax: 612-241-1943
Email: Admin@tctca.com

Record Request Form

To REQUEST records:
Complete and submit this form with signed Authorization Form
Click Here

Authorization Form

To AUTHORIZE sharing of records and information:
Submit this form completed and signed by client
Click Here

Questions? Contact our office at 612-202-8703