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Lotus Counseling Center

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    atrepagnier.lpc@gmail.com

    Forms

    Adult Intake

    Adult Intake Packet

    No Show/Cancellation Fee Form

    Credit Card Payment Authorization Form

    Declaration Form

    HIPAA Form

    Limits of Confidentiality Form

    PBI Patient Information Form

    Release of Information Form

    Child Intake

    Child Intake Packet

    No Show/Cancellation Fee Form

    Credit Card Payment Authorization Form

    Declaration Form

    HIPAA Form

    Limits of Confidentiality Form

    PBI Patient Information Form

    Release of Information Form

    Couples Intake

    Couples Intake Packet

    No Show/Cancellation Fee Form

    Credit Card Payment Authorization Form

    Declaration Form

    HIPAA Form

    Limits of Confidentiality Form

    PBI Patient Information Form

    Release of Information Form

     

    1 Galleria Blvd, Ste. 1900 #1903

    Metairie, Louisiana 70001

    504-444-1149 phone

    800-915-1248 fax

    atrepagnier.lpc@gmail.com

    ©2020 by Lotus Counseling Center