Optional information-sharing authorization or opt-out

Choose freely

Choose no optional sharing, or name one person you authorize to receive specific coaching information. This choice is not required to receive coaching. This form authorizes Perspect’s administrator and your booked coach to disclose only your selected information to that recipient for your stated purpose, after verifying the recipient’s identity. It does not authorize disclosure of ID documents, payment details, medical records, or signed legal-name documents.

Scope, expiration, and revocation

When authorizing, supply the person’s name and telephone number, information categories, purpose, and an expiration date. The authorization ends on that date unless revoked earlier. You can revoke it in your agreements portal; revocation does not undo a lawful disclosure already made. The recipient may redisclose information and may not be covered by Perspect’s privacy promises or HIPAA. Ask about a recipient’s practices before authorizing. This nonclinical authorization is not a substitute for a HIPAA authorization if one is legally required.

Safety remains separate

An authorized sharing recipient is not automatically your emergency contact, and an opt-out does not prevent legally required reports or lawful necessary emergency disclosures. No automatic messages will be sent to the person you name.

Official references

• 45 CFR §164.508: authorization requirements

Texas-focused guidance reviewed October 8, 2026. Other jurisdictions may differ.