Expiration: unless sooner revoked, this consent expires one year from the date of my discharge, unless otherwise indicated.
Form of disclosure: unless I have specifically requested in writing that the disclosure be made in a certain format, Cedar Recovery Center reserves the right to disclose information as permitted by this authorization in a manner that Cedar Recovery Center deem to be appropriate and consistent with applicable law, including, but not limited to, verbally, in paper format, or electronically.
Upon my request, I understand that I will be given a copy of this authorization for my records.
Note: if signature not witnessed by a staff member at Cedar Recovery Center, document must be notarized or presented with a copy of a valid photo ID with signature.