Release of Information I give permission for my treating clinician at Jonah Green and Associates, LLC to exchange informationClient First & Last Name With the following person, persons, or entities:Name Phone Address Email Name Phone Address Email Name Phone Address Email Jonah Green and Associates, LLC will limit its communications to matters necessary for evaluation, treatment and care coordination. Additional limitations on communication:Name of client or client’s guardian* Signature of client or client’s guardian* Date MM slash DD slash YYYY Name of client or client’s guardian* Signature of client or client’s guardian* Date MM slash DD slash YYYY Email* Therapist*Please SelectJonah Green, LCSW-CRicardo Andrews, MA, LGPCRachel Boxman, LMSWAron Carlson, LCSW-CHeidi Cohen, LCSW-C, CGABSAshley Copeland, LCMFTKatherine Doyle, LMSWJingshuai Du, LGMFTChris Erb, LCMFTJennifer Firestone, LCSW-CShannon Golub, LMSWShannon Harris, MSW InternYasmin Meyers, LCSW-CJamie Rosen, LMSWLori Rothfeld, JD, LMSWFarah Shirazi, LMSWJess Silbermann, LCSW-CNeysi Velasquez, MSW InternKathy Voglmayr, LCSW-CCAPTCHA Updated: 7/10/2020