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We value client referrals!

Acadiana Hope and Wellness Center, LLC accepts referrals from any individual or community partner invested in the life of the person(s) served. We accept referrals from Self, Primary Care Physicians, court appointed entities, DCFS workers, family members, and significant others just to name a few. Client intakes can be conducted through our website, by phone, through in person visits, and in the community on a regular basis. Upon contact from our office, our staff will provide an initial assessment date. Acadiana Hope and Wellness Center Staff prides ourselves in gaining the most accurate information to assist in providing quality client centered care. 

Make A Referral NOW!


Acadiana Hope and Wellness Staff appreciates you completing  the client intake form below in its entirety. Our staff will reach out as soon as possible to introduce ourselves and schedule your initial assessment. 

Name (First, Last, M.I.)*

Referred By:

Address*

Main Phone Number:*

Alternate Phone Number:

Email Address*

May we contact you via email?*

Marital Status*

Select an option

Sex:*

Date of Birth:*

Age:*

Race:*

SS#:*

Emergency Contact:*

Emergency Contact Relationship:*

Emergency Contact Phone Number:*

Primary Care Physician:*

Primary Care Physician Phone Number:*

Prior Mental Health Diagnosis?*

If yes, Please list:

Allergies:*

Presenting Problems: *

Additional Presenting Problems:

Current Therapist or Psychiatrist*

Therapist or Psychiatrist Phone Number:

Current Medications:*

Complete Intake by Phone

(337)514-2101 or (337)398-1000

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