Authorization to Use and Disclose Health Information
(from another provider/agency to Davis Behavioral Health

Authorization to Use and Disclose Health Information
(Spanish version)
(from another provider/agency to Davis Behavioral Health

Authorization to Use and Disclose Health Information
(from Davis Behavioral Health to another provider/agency

Authorization to Use and Disclose Health Information
(Spanish Version)
(from Davis Behavioral Health to another provider/agency

Client's Request for Amendment to Record

Client's Request for Amendment to Record (Spanish Version)

Client's Request for His/Her Own Records

Client's Request for His/Her Own Records (Spanish Version)

Authorization to Use and Disclose Health Information to the Court

Forms listed to the right all pertain to client records. If you are not sure which form will help you accomplish your desired action, please call our office and ask for help 801.773.7060. Forms are also available at any DBH office.

Davis Behavioral Health needs a client's authorization before sharing health records with other providers or agencies or in order to get a record from another provider.

By completing and submitting a form, clients can request an amendment to their medical records, or ask for a copy of their records.

Completed forms can be mailed or turned in at the DBH Main Street Clinic at 934 South Main Street in Layton, UT 84041.