RNLF Counseling Services
Caring and Compassionate Counseling.
Begin your Healing Today.
Call: (225) 924-9164
Forms
If your child or adolescent has been scheduled for their first appointment, please print the following forms and bring them in with you to your first visit:
- Child Intake Form
- Primary Care Provider Document
- Fee Schedule for Supplemental Clinical Services
If you and/are your spouse are scheduled for your first appointment, including couples counseling, please complete the following forms and bring with you to first session.
- Adult Intake Packet
- Primary Care Provider Document
- Fee Schedule for Supplemental Clinical Services
If requesting an appointment for someone 15 or older, please complete the online pre-screening MPact Questionaire. This will same valuable time during the check in process.
Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.
Adult Intake Form
Mental Status Interview Form
Adult Intake Complete (12-16-15).pdf
Adobe Acrobat document [381.4 KB]
Mental Status Interview Form
Adult Intake Complete (12-16-15).pdf
Adobe Acrobat document [381.4 KB]
Fee Schedule for Supplemental Clinical Services
Fee_Schedule_for_Supplemental_Clinical_S[...]
Adobe Acrobat document [258.2 KB]
Fee_Schedule_for_Supplemental_Clinical_S[...]
Adobe Acrobat document [258.2 KB]
Primary Care Provider Document
Primary Care Physician Notification Form[...]
Adobe Acrobat document [337.4 KB]
Primary Care Physician Notification Form[...]
Adobe Acrobat document [337.4 KB]
Additional Forms
Concent for Psychological Testing
Consent for Psychological Evaluation.pdf
Adobe Acrobat document [16.6 KB]
Consent for Psychological Evaluation.pdf
Adobe Acrobat document [16.6 KB]
AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION
Authorization.pdf
Adobe Acrobat document [77.9 KB]
Authorization.pdf
Adobe Acrobat document [77.9 KB]
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