Referral Form for Physicians & Community Providers

We are committed to a collaborative effort in treating individuals with mental health concerns, and we believe that communication with other treating providers is the key to successfully helping those in need. Our staff strives to collaborate with community providers to meet the needs of our clients. If an individual you are working with is in need of a mental health referral, please complete the form below. Our staff will contact the referral directly within 24 hours to discuss scheduling an appointment, and we will update the referring provider after the first appointment is kept. If you prefer to fax a referral form, please download our referral form and fax it to us at 225-290-3324.

Referring Provider Information:

For Medicaid Referrals Only:

Client Information:

For Children Only:

Schedule New Client Appointment

If you would like to schedule new appointment with a therapist at JTL, please complete the form below. A member of our staff will be in contact with you in the next 24 hours to discuss scheduling options. If you would like to speak with someone directly, please contact our staff at 225-290-3313.