Client Forms

Client Documents

We want to make your appointment at South Central Louisiana Human Services Authority (SCLHSA) as helpful and smooth as possible. Bring these completed forms with you and present them when you check-in for your appointment. Please have your most current insurance card and picture identification with you. If you have an insurance co-pay, this will be required to be paid prior to your visit.

  • Notarized Statement of Income : This form helps us calculate the cost for your services. Please print and have it completed before your visit.
  • Notice of Privacy Practices 12.1.13 : This is for you to review. You do not need to print or bring for your visit.
  • Client Handbook : This is for you to review. You will receive a copy at your first visit. This handbook will help you understand your Rights and Responsibilities and includes our Orientation to Services.
  • Advance Directive Form : If you already have an Advance Directive, please bring a copy with you. If you do not, but are interested in getting one or learning more about it, click the link or ask us about it at your visit.

 

SCLHSA has agreements with the following companies that may cover your Behavioral Health care. You can contact your insurance provider to determine your network benefits.

  • Blue Cross Blue Shield
  • Verity
  • Gilsbar
  • Medicaid
  • Medicare