Consent to receive services

Please sign below

First Name

Last Name

Email

I consent to receive services from VCRN clinicians. I understand there will be no charge for these services. I authorize VCRN to provide early intervention to alleviate presenting symptoms and decrease distress.

Your Signature

Thanks for submitting!

Virginia Community Response Network

Our mission is to develop, train, and maintain a team of licensed and license-eligible volunteer clinicians to respond to community disasters in Virginia by providing Eye Movement Desensitization and Reprocessing (EMDR) services to victims to minimize the emotional effects of a traumatic event.

Email: contact@vcrn.org

Phone: 434-202-6322

Facebook: @VirginiaCRN

Instagram: @VirginiaCRN

LinkedIn: @VirginiaCRN

Donate to VCRN

Quick Links

bottom of page