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New Patient Information

Due to the high volume of applications, Mercy Family Center is now on a waiting list.  We are extremely sorry for any inconvenience that this may cause and are doing our best to schedule as many clients as possible.  If this is an emergency or you feel as though you are a danger to yourself or others;  please call 911 or the COPEline (504) 269-2673 for immediate assistance.  

Mercy Family Center is currently unable to meet the demand for psychological or educational assessments.  The identification of conditions that prevent children from achieving in school has been an integral part of Mercy Family Center’s service to the New Orleans community for the past 19 years.  However, we are currently backlogged with requests for assessments and highly recommend that parents seek other providers in the community to provide this service.  A list of local licensed psychologists who provide psychological and educational assessments can be found by clicking here. 

Note: All applicants must fill out the Initial Intake Form before acceptance to Mercy Family Center for service. Please read the following information below
and click ACCEPT to apply.

“Please remember that Mercy Family Center is primarily a child and adolescent behavioral health practice. Therefore, we reserve the right to screen clients for their appropriateness to our practice. Thank you.”

Introductory Consent to the Use and Disclosure of Health Information
for Evaluating Potential New Patient

I understand that as part of my (or my child’s) New Patient Intake Evaluation, Mercy Family Center originates and maintains paper and/or electronic records describing my (or my child’s) health history, symptoms, examination and test results, diagnoses and treatment. I understand that this information serves as:

• A basis for evaluating potential care and treatment,
• A means of communication among the Mercy Family Center clinical staff who may be asked to contribute to my (or my child’s) care,
• A means by which a third-party payer can verify that services being considered are covered under my (or my child’s) health plan.

I understand that the information I provide will be used only by Mercy Family Center staff and disclosed only to a third party payor to verify my insurance coverage during this intake evaluation process. I understand that if I (or my child) is accepted as a patient by Mercy Family Center, I will be asked to sign a New Patient Consent Form and will be provided with a Notice of Information Practices that details a complete description of protected health information uses and disclosures by Mercy Family Center. I understand that if I (or my child) am not accepted as a patient, all protected health information I have provided to Mercy Family Center will be destroyed. No record of my intake evaluation will be retained by Mercy Family Center.

I understand that I have a right to decline this consent. I also understand that by declining this consent, Mercy Family Center may refuse to treat me as permitted by Section 164.506 of the Code of Federal Regulations.

I fully understand and accept (per location) / decline the terms of this consent.


Be sure to check the appropriate acceptance buttons for Children or Adults below:


For CHILDREN (Only)

Accept the appropriate location:

Accept
(Child-
Project Fleur de lis)


110 Veterans Blvd, Suite 425
Metairie, LA 70005
Phone: 504.838.8283

1445 West Causeway Approach
Mandeville, LA 70471
Phone: 985 727-7993

3221 Behrman Place, Suite 105
New Orleans, LA 70114
Phone: 504.376.2590
   


For ADULTS (Only)

Accept the appropriate location:


110 Veterans Blvd, Suite 425
Metairie, LA 70005
Phone: 504.838.8283

1445 West Causeway Approach
Mandeville, LA 70471
Phone: 985 727-7993

3221 Behrman Place, Suite 105
New Orleans, LA 70114
Phone: 504.376.2590
   

 

 

Hurricane Assessment Instrument Below

Hurricane Assessment Instrument

The following survey will allow our clinicians to better serve your child and family by identifying possible Hurricane-related stressors. Please take a moment to complete as much of the survey as is relevant to your child’s personal experience.

Thank you.




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