Requesting Medical Records: Your information is confidential between you and your therapist. You may review or request a copy of your records at any time. We will only release information with a signed Records Release Authorization from you or a court order. Please note, in the State of Washington, all clients age 13 and older are legally required to sign a release of information in order for mental health information to be shared. Please allow at least 15 days for your record to be copied.

adobe_readerPlease read all information and instructions before completing and signing the authorization form.  There may be a charge for copies of your medical records unless your copies are being sent to another health care facility or a physician.

Records Release Authorization Form

If you have any questions, please contact our Records Release department at 425.869.2644, ext. 0 or fax your information to 425.867.0930.


Additional Information: Many clients ask Emmaus Counseling Center to communicate by fax. It is our policy to use fax transmissions when necessary for treatment, payment or healthcare operations. By providing Emmaus Counseling Center with a fax number, you are consenting to Emmaus Counseling Center’s use of that number for communicating with you by fax.

Client Rights: You have the right to revoke or cancel this authorization, in writing, at any time.

Cancellation Notice: According to the Uniform Health Information Act for the State of Washington, records shall be released within fifteen days after receipt of a signed, dated release form. Since records are usually handled within 2 – 3 days after receipt, Emmaus Counseling Center will not be held responsible for any release of records accomplished before receipt of a written notice of cancellation. Revocation takes place from the date of receipt of written request.

Instructions for Canceling a Request:

  • You must provide a written request to Emmaus Counseling Center’s Records Management Department asking for revocation/cancellation of the original record release.
  • We need to have your complete name, date-of-birth, telephone number (home/work) and the name of the person/agency that you authorized to receive the medical information.
  • After receipt of the notice, we will confirmation and acknowledge your withdrawal of authorization via telephone.
  • If the release has been accomplished, you will be notified by a staff member. The release will be revoked for any further disclosure.
  • If you have any questions concerning the cancellation process, call the business office at 425.869.2644, ext. 0.

Washington State Laws regarding Record Retention:

  • Master Level Therapists:  WAC 246-809-035: The licensed counselor or associate or the associate’s supervisor must keep all records for a period of five years following the last visit.
  • Psychologists: WAC 246-924-354: All records must be retained for at least eight years following the last professional contact with the client(s). In the case of minors under the age of eighteen, the records must be retained until the client reaches the age of twenty-two or for eight years, whichever is longer.