Catalpa Health Privacy Department

Our Privacy Department will need to obtain documentation when there is a court-appointed guardian, out-of-home placement, or a parent with sole legal custody. Please note, the rules for mental health services are different in some ways than what you may experience in a primary care doctor’s office. A step-parent, grandparent, or foster parent may be significant in a child’s life but is not able to consent for treatment, medication, or records release.

Please use this form to submit legal documentation or delegation/power of attorney paperwork to Catalpa’s Privacy Department.

Feel free to call us at (920) 702-3204 if you have any questions or have trouble using this form.