Release of Information

Gateway Academy understands the importance and sensitivity of private health, medical, and financial information. We also understand the importance of giving easy access to a youth’s records, while keeping those records private.

Requesting Confidential Records 


  1. To request a copy of a youth's MEDICAL OR FINANCIAL RECORDS (not transcripts) please complete the form found at the following link:  Request for Information

  2. The link will take you to a DocuSign Release of Confidential Information form.

  3. Enter your full name and email address and select Begin Signing”.

  4. Select “Continue” to open the Release.

  5. Complete the Release in its entirety.  Incomplete Releases will delay processing.

  6. Select the box to agree to use electronic records and signatures and select “Finish”.

  7. We will contact you with questions or in the event there is a processing fee.

  8.  The records will be sent to the listed email address.

  9. All requests for records will be subject to Gateway's Notice of Privacy Practices. Gateway's Privacy Practices can be found at the following link: Notice of Privacy Practices


There is no cost for electronic records if you are a parent or past client making a request to be sent to another provider/facility such as a physician’s office or attorney.

A release of Information must comply with state and federal guidelines. Gateway records include medical records, enrollment records, and clinical records in whole or in part, that Gateway used, created, or relied upon in the course of diagnosis and treatment of clients.

Records may be released to parents of a past client.  In the event the past client is eighteen (18) years of age, the student must sign the Release of Information form.

If you have any questions or issues regarding the confidential records release of information process please contact Millie Butterfield at, or at (801) 523-3479.