Forms

Prior to Scheduling Your Initial Appointment:

• First, review the Accepted Insurance Plans tab to ensure your insurance carrier is accepted.
• All new clients are pre-screened prior to an initial counseling appointment being scheduled. Please email or phone the therapist to complete the screening process.
• Upon the completion of the pre-screening process, Dr. Jackie will send intake forms via secure email. Please complete all necessary forms prior to your initial appointment. Should you need assistance with the completion of the forms, please advise the therapist.
  • Necessary Forms to be completed includes:
    • Informed Consent for Services Consent to Use or Disclose Information for Treatment, Payment, and Health Care Operations the Adult Intake Questionnaire OR the Child and Adolescent Intake Questionnaire Authorization to Release Confidential Information (Optional) Litigation Participation Policy Credit Card Authorization Form
      • Please Provide a copy of the front and back of your insurance card, driver’s license, or state identification card as indicated within the Adult Intake Questionnaire and Child and Adolescent Intake Questionnaire
      Please Note: The Declaration of Practices and Procedures and the Notice of Privacy Practices is included in the intake packet; please retain both documents for your records. These documents do not need to be returned with the forms indicated above. Please email the completed forms to secure email: healingtalktherapy@gmail.com or fax to 504.553.1154  
  • To Book a Counseling Session with Dr. Jackie Meyers, LPC-S, LAC, NCC, submit an email inquiry to healingtalktherapy@gmail.com or phone: 504.814.9098

• NEW CLIENT ALERT: Please book your initial appointment and email forms at least three days prior to your initial session. This request is to allow adequate time to prescreen and verify your insurance benefits.