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Release Form

Authorization for Release of Information

Please read and complete this form for the Clinic to release or receive information per your needs. Instructions on completing the 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 email us at clinic@unc.edu

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Commitment to Diversity

The UNC Psychology and Neuroscience Community Clinic is committed to promoting diversity and inclusiveness in service of the goal of providing sensitive and competent care to all. We define diversity broadly including race, ethnicity, sex, sexual orientation, gender, gender identity, age, national origin, disability, socioeconomic status, religion, immigration status, and other attributes that contribute to one’s social identity. We maintain a commitment to treat all clients as valued and respected individuals across all differences.