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  • Client Medical Information

  • Referral Source

  • Release of Information

  • If you are requesting services on behalf of someone else, please have them sign a release of information form to allow communication between you and ERI. Download a Consumer Consent to Release Information Form (WORD)

    If you have a completed form, please upload and attach to this form. Otherwise, you can email, fax, or send a consent form to ERI upon completion.

  • Max. file size: 98 MB.
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