LifeCare Alliance’s funding sources and community partners monitor the effectiveness of programs offered to its consumers. Therefore, it may be necessary for LifeCare Alliance to provide written or verbal health related and financial information for the purpose of providing and coordinating services received from the Agency. All information will be kept confidential and no personal identifying information will be released to the public without written consent, unless required under Federal law. Although all persons receiving services are asked to provide this information, no person may be denied services for refusing to provide any of the requested information. By submitting this completed online referral form to LifeCare Alliance, I agree that I have read the Release of Information statement and understand that my submitted information may be reported, as needed, to LifeCare Alliance’s funding sources and community partners.