Skip Navigation

Case Manager Release Form

I hereby grant my permission for BANGORHOUSING, to release confidential information and material to the below named agency’s person.

My signature on this release also allows the above-named agency’s person to release any confidential information and material to BANGORHOUSING.

I understand that no such information or material will be released without this specific permission except where provided by law. I also understand that I have the right to review copies of any information or material released and to revoke this permission in writing at any time.

MM slash DD slash YYYY