The below form needs to be downloaded, read, signed and brought to your initial meeting with your GRC care provider. You can also send signed copies electronically (pdf or photo) to GRC’s director of on-field care at <erik@godspeedresources.org>. He can put them in your file so that you can make the most of the allotted time with your care provider.  If you wish to discuss these prior to signing, your care provider will have copies on hand and will review them at the start of your session.

Professional Disclosure Statement & Informed Consent

 

This form is not necessary to sign if you’re only meeting with your care provider in person. However, if you plans to or may at some point connect with your care provider via video in the future, then please go ahead and sign the below form. We’ll keep it in your file and it’ll allow you to schedule a video counseling session much quicker.

Tele-Mental Health Informed Consent

 

Should there be a need or desire to have anybody else involved throughout the counseling process (family member, pastor, organization, another professional, etc.), then an Authorization for Release of Information (ROI) form will need to be filled out and signed.  This signed form gives your care provider legal permission to discuss relevant details of your case and progress with the party/ parties indicated.  

Authorization for Release of Information

 

If someone else will be handling the financial aspect of your care, then we’ll need you to sign a financial ROI form that gives GRC’s finance department permission to share basic date/ time details with the donor so that they can make a contribution on your behalf.

Authorization for Release of Information - Financial