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Release of Information

Evolve Mental Health, PLC
Tiffany Melberg PMHNP-BC

Records to obtain and have faxed to Evolve before your 1st visit will be scheduled:

– Last visit note from your primary care and lab

– Medication and supplement list current and past

– Last 2 visits with mental health provider (if applicable)

– Last mental health intake (if applicable)

Complete a release of information (ROI) with your provider/s and have them fax to:

Evolve Mental Health, PLC
1830 East Century Avenue, Suite 1
Bismarck, ND 58503

Phone: (701) 751-0699
Fax: (701) 401-0299

You can ask your facility about the time it may take to have this completed, typically, when filling this out with them.

THANKS TIFFANY!