I, the undersigned, understand that my alcohol and/or drug treatment records and mental health records are protected by federal and state regulations and cannot be disclosed without my written consent unless otherwise provided or in the regulations. I understand that some of the confidential information I have authorized to be disclosed will be generated and disclosed over the course of my future service/treatment and after the date I signed this authorization. I also understand that I may revoke this consent in writing at any time except to the extent that action has been taken in reliance on it, and that in any event this consent expires automatically on the date or condition below: