Patient Forms

c

Patient Information

h

Policies & Fees

i

Insurance Information

n

Health Information Policy

b

Coordination of Care & Consent

b

Telehealth Informed Consent Document

b

LSBSWE Distance Therapy

b

LSBSWE Professional Disclosure Statement

  1. Patient Form Instructions

The button icons will download electronic form PDFs.
You can fill out the forms in most pdf viewers,
save-as with your name, and send
the PDFs using the form below.

Or, you can print the forms, fill them
out by hand, and fax to 504-355-0508.

We may call you for additional information.

Your Name (required)

Your Email (required)

Your Phone (required)

Attach Forms

Patient Information

Policies & Fees

Insurance Information

Health Information Policy

Coordination of Care & Concent