Providing Your Consent

You'll need to provide your consent to gives GDABVI and CharityTracker (our case management software) permission to use and disclose your individually identifiable health information for treatment, payment, and/or healthcare operations. If you complete our online intake form, providing consent will be included in that process. Intake can also take place person-to-person with someone from our office. You will need to complete intake to receive services from the Greater Detroit Agency for the Blind and Visually Impaired.

 

We take your privacy seriously and will protect your information. View and download our Privacy Practices here.

 

Click here to complete the online Consent Form

(You only need to use this form if you aren't completing our online intake form.)

 

If you need assistance completing our service forms, please call our office at 313-591-3793 (or our main line at 313-272-3900) to request help.
We look forward to working with you!