I understand that I may revoke this authorization at any time. This authorization is valid indefinitely until canceled by me, unless otherwise specified. I understand that when Austin Neuropsychology is releasing information to an outside person/entity, this information will be provided wihtin 15 business days from reciept of request and that a fee for preparing and furnishing this infomation may be charged according to ruling set forth by the Texas State Board of Medical Examiners.
Unless specifically restircted, this release encompasses entire record including information pertaining to mental health, drug/alchol use, and HIV/AIDS.