CAPS will provide a record or summary to a third party, such as an insurance carrier, or to another treating professional providing mental health services. There is a process to help you with your request. It is important to note that in keeping with the ethical and legal standards of confidentiality, your written permission is necessary to share any information about your treatment at CAPS.  Written permission includes a CAPS Release of Information form. (More below regarding this form)

Generally, CAPS issues a treatment summary or letter outlining services. If you are requesting an entire record, we would want to discuss this process with you. We consult as needed within the staff of Counseling and Psychological Services. If you are requesting completion of a third party company's form (insurance application, for example), we still need your signed CAPS Release of Information form.

PLEASE FOLLOW THE STEPS BELOW

    Complete a CAPS Release of Information form and return it to CAPS one of the following ways:

      1. FAX: (215) 573-8966  
      2. Email attachment: wallacek@upenn.edu 
      3. USPS: CAPS 3624 Market Street, First Floor West, Philadelphia, PA  19104-2615

        If you have a third party form to be completed, please complete your portion and send it to CAPS with your CAPS Release of Information form.