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Clinic for Counseling and Personal Development (CCPD)

New Client Forms

Please print and complete the necessary forms below ONLY if you have been scheduled for an intake appointment at the Clinic for Counseling and Personal Development at the Picard Center. If you are unsure if you have been scheduled, please call us at (337) 482-1018.

*Please note: If the appointment is for Family/Couples Counseling, the appropriate paperwork (Adult/Minor) must be completed on each individual receiving counseling.

This paperwork is necessary for adults to complete for themselves and/or their minors/children before being seen for counseling sessions. This paperwork also includes information about our recording policy, as we are a training clinic under the supervision of Board approved Licensed Professional Counselor Supervisors (LPC-S) through the Licensed Professional Counselors Board of Examiners of Louisiana.

When coming in for the intake appointment, please remember to bring completed paperwork along with the one-time, non-refundable $25.00 intake fee, payable by check or money order only made out to: “UL Lafayette.”

Weekly Caregiver Report