Records Requests

Please use these forms if you would like to request records from The Center for Mental Health. A valid (ROI) Authorization for Use and Disclosure of Health Information is required for any outside records requests.  This form can be faxed to (970) 252-3208 or brought in to any of our locations.

Records Request (fillable) 2.21.2019

Individuals request for access to PHI (fillable) 2.21.2019

ROI-MH_SUD (FILLABLE) 08222018

SPANISH-ROI_MH_SUD (fillable) 1152018