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    811 North Harrisville Road | Harrisville, UT 84404
    Aloha@AlohaBehavioral.com | (801) 399-1818

  • Aloha Behavioral

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    • Home
    • Telehealth
      • Telehealth Appointments
      • Covid-19 Resources
    • About
    • Our Providers
      • M. Shawn Palau, LCSW, NOJOS
      • Brant Fonnesbeck, DO
      • Yvette Palau, Executive Director
      • Kristin Kaserman, LMFT, NTS, Reiki Master, MAT Director
      • Reena Green-Josoff, LCSW, Associate Clinical Director
      • J. Richard Rees, MD
      • DJ Ballingham MSEM, MSPAS, RN, PA-C
      • Lynda Lazar, APRN
      • Marcia Andersen, CMHC
      • Cara Webb, LCSW, NOJOS
      • Bailey-Hoover, AAT Certified
      • Lulu-Mopster, AAT in Training
      • Stephanie Woolworth, CMHC
      • M. Andrew Montgomery, LCSW, MBA
      • Kristin Orgill, LCSW
      • Mason Stevens, LCSW
      • Jaime Tracy, LCSW
      • Andrea Snyder, CSW
      • Mandee Rodriguez, Office Manager
      • Carli Berger, Billing Specialist
      • Sierra Corey, Administrative Specialist
      • Sloan Becker, Administrative Specialist
      • Mallory Griego, Administrative Specialist
    • Services Provided
      • Counseling & Therapy
      • Addiction Treatment
      • Psychiatric Medication Management
      • Intensive Outpatient Program (IOP)
      • Genetic Testing
    • Getting Started
      • FAQs
      • Rates and Insurance
      • Patient Forms
      • Request an Appointment
    • Pay Now
    • Resources
      • Mental Health Articles
      • Mental Health Education
      • Physical Health Education
      • Local Resources
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    Patient Forms

    Medical Records, Letter Requests, and Release of Information (ROI)

    If you are requesting a letter or medical records, please fill out a Release of Information (ROI) and Medical Records and Letter Request Form and turn them into our office. Please allow up to 14 days for requests.

    Should you need to share information with another individual or facility, you will need to fill out a Release of Information and turn it in to our office.

    Release of Information (ROI)

    Medical Records and Letter Request Form


    If you are a new patient, please have the following forms filled out prior to your first appointment. Please bring these forms with you, or plan on coming to your appointment about 15 minutes early to fill them out in the office. Please bring your ID and insurance cards with you to your appointment.

    New Patient Registration Forms


    Contact Today

    811 North Harrisville Road
    Harrisville, UT 84404

    (801) 399-1818
    Aloha@AlohaBehavioral.com
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    Contact Today

    Aloha Behavioral Consultants
    Aloha@AlohaBehavioral.com | (801) 399-1818

    A Website by Brighter Vision | Privacy Policy

    • Home
    • Telehealth
      • Telehealth Appointments
      • Covid-19 Resources
    • About
    • Our Providers
      • M. Shawn Palau, LCSW, NOJOS
      • Brant Fonnesbeck, DO
      • Yvette Palau, Executive Director
      • Kristin Kaserman, LMFT, NTS, Reiki Master, MAT Director
      • Reena Green-Josoff, LCSW, Associate Clinical Director
      • J. Richard Rees, MD
      • DJ Ballingham MSEM, MSPAS, RN, PA-C
      • Lynda Lazar, APRN
      • Marcia Andersen, CMHC
      • Cara Webb, LCSW, NOJOS
      • Bailey-Hoover, AAT Certified
      • Lulu-Mopster, AAT in Training
      • Stephanie Woolworth, CMHC
      • M. Andrew Montgomery, LCSW, MBA
      • Kristin Orgill, LCSW
      • Mason Stevens, LCSW
      • Jaime Tracy, LCSW
      • Andrea Snyder, CSW
      • Mandee Rodriguez, Office Manager
      • Carli Berger, Billing Specialist
      • Sierra Corey, Administrative Specialist
      • Sloan Becker, Administrative Specialist
      • Mallory Griego, Administrative Specialist
    • Services Provided
      • Counseling & Therapy
      • Addiction Treatment
      • Psychiatric Medication Management
      • Intensive Outpatient Program (IOP)
      • Genetic Testing
    • Getting Started
      • FAQs
      • Rates and Insurance
      • Patient Forms
      • Request an Appointment
    • Pay Now
    • Resources
      • Mental Health Articles
      • Mental Health Education
      • Physical Health Education
      • Local Resources
    • Blog
    • Contact