In order to request the treatment records of a previous HelpSource client, you must make a written request that includes the following information:

             1. Full Name
             2. Social Security Number 
             3. Date of Birth
             4. HelpSource program association
             5. Address to which records should be mailed
             6. Administrative fee of $30
                (payable to Big Brothers Big Sisters of Washtenaw County)

If you are anyone other than the former HelpSource client, you must indicate your full name, relationship to the former HelpSource client, and the reason for the records request. We will review each request to ensure HIPPA standards are met.

It would be very helpful to have a phone number or email address where you can be reached, so that we may contact you if there are any concerns while we are processing your request.

Please send all written requests to: 
             Big Brothers Big Sisters of Washtenaw County
             Attn: Jennifer Spitler
             2890 Carpenter Rd.
             Suite 1400
             Ann Arbor, MI 48108