Get Help:  (225) 810-3967
Get Help:  (225) 810-3967
RNLF Counseling Services Caring and Compassionate Counseling. Begin your Healing Today. Call: (225) 924-9164
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.

Child Intake Form
Child Intake Form.pdf
Adobe Acrobat document [408.8 KB]
Adult Intake Form
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]
Primary Care Provider Document
Primary Care Physician Notification Form[...]
Adobe Acrobat document [337.4 KB]
MPaCT Questionnaire (complete online)
MPaCT Questionnaire(1).pdf
Adobe Acrobat document [461.6 KB]

Additional Forms

RNLF Counseling Services Flyer
RNLFCS_brochure.pdf
Adobe Acrobat document [6.5 MB]
Testing Agreement
Testing Agreement (12-16-15).pdf
Adobe Acrobat document [55.2 KB]
Concent for Psychological Testing
Consent for Psychological Evaluation.pdf
Adobe Acrobat document [16.6 KB]
Records Release Form
RECORD RELEASE.pdf
Adobe Acrobat document [69.6 KB]
Referral Form
RNLFCS Referral 2015 Updated.pdf
Adobe Acrobat document [535.4 KB]
AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION
Authorization.pdf
Adobe Acrobat document [77.9 KB]

Schedule an Appointment

Private Practice

7569 East

Industrial Dr.

  Baton Rouge, LA 70805

 

 Ph: (225) 924-9164

(225) 924-3430  

  Fax: (225) 924-5479

Email:   

info@rnlfcounselingsvs.net; 

dr_ltennart@rnlfcounselingsvs.net

Online Scheduling

https://live.vcita.com/site/chaplain.l.tennart

 

 

Business Hours

Mon-Fri

9:00am-5:00pm

Sat

(Appt only)

 

Are you experiencing symptoms of a mental health condition?

Call or come by to take one of our simple and easy screening tests now.

It’s completely anonymous.

 

Support Better Mental Health

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