In order to intervene on your behalf, THSC frequently finds that we must have a signed privacy release. Please provide the name(s) of the organization(s) that we need to contact in the appropriate place on the form so that your request is not delayed due to this missing information. Be sure to provide any applicable case or reference number(s) that we will need to provide to the organization.
Note this is optional for many questions. We may not need privacy release if we do not need to contact anyone on your behalf, however, in the event it is required, this can be submitted now, or can be emailed to our team upon request later. Documents may also be sent to email@example.com
Download, sign, and attach the privacy release.