Please complete the following Telehealth Informed consent. Please note: Use the right scroll to move down the form, initials are required throughout the form and it is very long - you've reached the end when you add your signature and date.

If you are experiencing a life threatening emergency CALL 911 or go to your nearest emergency room. 

TEL: (225) 924-6621

FAX: (225) 924-6627

4939 JAMESTOWN AVENUE, SUITE 101

BATON ROUGE , LA 70808

© 2020 by Grief Recovery Center - All Rights Reserved.