Release of Information Form Release of Information Form Fill up the form or simply download the PDF here. Release of Information Name* First Last Relation to Child*ParentGuardianChild Name First Last Agreed to work withInformation may be disclosed:*Any information obtained during the course of providing sleep coaching servicePut in the "other" field the Information limited toThis information may be shared by phone or in writing for the following purpose(s):*treatment planning or coordinationmedical diagnosis by a licensed health professional retained by meThis consent is valid for a period of*DaysWeeksMonthsYearsChoose only one