Records Request Brighter Futures Counseling, PLLC is happy to provide the first copy of your mental health records free of charge. Please understand fees are associated for any request thereafter. Service Updates will include all services the client is involved with at Brighter Futures Counseling, PLLC including dates attended, participation/involvement level, ongoing recommendations, and any concerns noted by the provider.Type of Request* Complete Mental Health Record (30 Business Days) Mental Health Assessment Only (30 Business Days) Certified Mental Health Record (30 Business Days) Rush Request (less than 10 days notice) Rush Request (less than 30 days notice) Service Update (10 Business Days) Letter (14 Business Days) Specific Dates of Service (30 Business Days) Time frames for each request is provided. Please note that Brighter Futures Counseling, PLLC will do our best to provide requested records as soon as possible and within the timeframe listed. If specific dates of service or information for letter is needed, please indicate date range or desired content. Please explain any additional details about your request:*Brighter Futures Counseling, PLLC must have one of the following on file in order to release information:* Client/Guardian Signed “Brighter Futures Counseling Authorization to Release Information” Valid Court Order Valid DCBS Investigation Letter Today's Date* MM slash DD slash YYYY Client Name* First Last Client DOB* MM slash DD slash YYYY Client/Guardian Phone*Client/Guardian Email* Client Court Date MM slash DD slash YYYY Judge Name First Last Needed Date* MM slash DD slash YYYY Although Brighter Futures Counseling, PLLC will do our best to have all requests completed within requested timeframe, please note date of completion may be effected by type of request.Person Requesting Records* First Last Relationship to Client/Agency* Phone*Email Preference on how records are sent--please also include the necessary contact information below...* E-mail Mail (Additional fee may apply) Fax Pick Up In Person (A specific pick-up time must be scheduled) Emailed to: Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Faxed to:Picked up in person at Brighter Futures Counseling, PLLC by: ***If you need additional information from Brighter Futures Counseling, PLLC or would like to request a specific part of the clients record — please send those requests to: firstname.lastname@example.org *** There is no charge for service update requests. Additional Fees: Certified Records: $35.00, **If you need your records rushed--there is an additional charge based on how quickly you need them. Rushed Records fee with less than 30 days notice: $15.00, Rushed Records fee with less than 10 days notice: $30.00 Letters: $130.00/hour with $10.00 minimum, also records following first free copy are $0.5 per page with a minimum of $5.00 per request.