Release of Information

Healing for the Soul Coaching

Release of Information

PO Box 25314,
Colorado Springs, CO 80936
Phone: 719-590-SOUL (7685)

I, (client’s printed name) give permission for Jayson Graves, Healing for the Soul and all its agents to communicate with the following person(s) regarding the confidential information of our coaching relationship:

I understand that the information shared and gained about me, my coaching and all other personal information will remain confidential within these relationships and is still governed by all applicable confidentiality laws of my state and the State of Colorado.


Leave this empty:

Signature arrow sign here

Signature Certificate
Document name: Release of Information
lock iconUnique Document ID: 9d52fa1d403458febae650dacd60b686d722155c
Timestamp Audit
February 12, 2019 12:47 pm MSTRelease of Information Uploaded by Erin Duckworth - IP