This form can be completed online and a copy will be emailed to you and the clinic. The form engine used is HIPAA and PCI compliant.
Fillable Form: Healow televisit consent
1525 Dickory Avenue | Harahan, LA 70123 | Phone: 504-818-0006 | Fax: 504-818-0095
Open 365 Days A Year
Mon – Fri: 8 a.m. – 8 p.m.
Sat – Sun: 9 a.m.- 5 p.m.
Weekends and Holidays:
9 a.m. – 5 p.m.
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