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Free Tool: Release of Information Form

A woman looks at paperwork held by a man. Both wear glasses and are smiling. This image represents a care provider helping navigate paperwork and care coordination.
Care coordination = Better healing

Coordinated Care After Brain Injury Starts with Communication and Permission


Enter, the Release of Information Form (ROI)


Effective support for brain injury survivors requires a team, often across multiple disciplines and systems. Good teams need good communication. Our Release of Information (ROI) form is designed to facilitate clear, ethical, and client-empowered collaboration.


Why automatically include an ROI Form?

Ideal brain injury recovery often includes providers from:

  • Mental health (therapists, neuropsychologists, case managers)

  • Medical care (neurologists, PCPs, rehabilitation physicians)

  • Rehabilitation services (OT, PT, SLP, vision therapy)

  • School or workplace supports (504/IEP teams, HR, disability services)

  • Community-based support (peer mentors, housing programs, vocational training)


These systems don’t always talk to each other, and survivors shouldn’t have to be the messenger. Our ROI form ensures everyone involved in care understands the client’s needs, challenges, and goals, with the client’s full consent and control.


Our ROI form empowers clients to:

  • Choose who they want us to speak with

  • Define what information they’re comfortable sharing

  • Set limits on how long the release is valid

  • Revoke consent at any time

  • Quickly and easily choose professionals related to their injury or illness


For Providers: If you’re referring to Duende or already working with one of our clients, we can connect with you directly, with the client’s signed permission. This helps us reduce duplicated services, improve outcomes, and ensure each part of the client’s recovery story is understood in context.


We believe in collaboration, transparency, and trauma-informed communication. Our ROI process is designed to support all three. Please feel free to use this resource and craft it to meet your needs.


In community and understanding,

The Duende Team


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Stay Connected with Us

(970) 458-5773

@braininjurytherapy

Grand Junction, CO 81501, USA

Refer a Survivor

Know someone who may benefit from therapy or support after a brain injury?


We welcome referrals from providers, care teams, schools, case managers, and family members.

Use our secure referral form to start the process.

 

 

 

Please do not include confidential health information in the form. We will contact you directly for any protected details.

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