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Authorization to Release Protected Information

Please read and complete this form based to enable the Clinic to release or receive information per your needs.

The Psychology and Neuroscience Community Clinic is solely appointment based and we cannot accept walk-ins. We do not have a full-time staffed telephone number nor 24/7 emergency coverage. For emergency services, please see this link. Providers wishing to refer a client to us, please fill out our Contact Us form.

Thank you! We hope to respond to your inquiry within a couple of business days. At the start of the academic semester, August/September and January/February, we receive a large amount of inquiries and may be slow to respond.

If you have not received a response within a couple of business days, please leave a message on the clinic voicemail, 919-962-6906, or you email us at