Release Form

You will need to click on the link below to download and print the PDF file.

Please fill out the form completely and remit with signatures to Lisa Brown
via , via fax at 732-380-7508, or by mail to:
Recovery Innovations, c/o Lisa Brown, 1 Corbett Way, Eatontown, NJ 07724.

The form must be signed by you before it is returned to our offices.
Thank you for your cooperation.

RECOVERY INNOVATION CONSENT TO RELEASE CONFIDENTIAL INFORMATION FORM