Ark Counseling, LLC Has Permanently Closed

To obtain a copy of your Diagnostic Assessment or Discharge Summary click “DOWNLOAD FORM” below and complete the following release (Permission to Disclose Privileged and Confidential Information and Records). The requested records will be surfaced mailed within 30 calendar days of receiving a written request.

HIPAA and MN Law permit healthcare providers to charge reasonable fees for making copies of medical records: $20.35 for retrieval fees; $1.53 per page. The average Diagnostic Assessment is 7 pages ($10.71) and the average Discharge Summary is 7 pages ($10.71). Ark charges a flat fee of $30 for records that includes: retrieval plus coping fees. In addition, there is a $30 fee for all dishonored checks.

Mail the completed and signed Release, a copy of a current government issued photo ID, and a check for $30 (payable to Jerry Holt) to:

Jerry Holt
Records Custodian for Ark Counseling, LLC
1240 Hagler Ridge Road
Springville, TN 38256

Mr. Holt is not able to modify the content of Diagnostic Assessments of Discharge Summaries. These documents were signed by a licensed therapist. If you have an issue with something in the document, contact the therapist who signed the document. Their contact information is available through the MN Board of Behavioral Health and Therapy.