In the midst of the current COVID-19 Pandemic, PELICAN STATE OUTPATIENT CENTER has partnered with RemoteMD, a leader in Remote Medical Services, to provide comprehensive Telehealth. Our Tele-Triage, Tele-Medicine and Drive-Thru Screening Services are now being offered to accommodate YOU & YOUR NEED TO KNOW! Main Line: (504) 818-0006.

Fillable Form (televisit): Patient Information, HIPAA Consent, Televisit Consent

This form can be completed online and a copy will be emailed to you and the clinic.
Please attach clear and legible pictures of your insurance card(s), if applicable.
If you are filling in this form on your phone or a tablet you can directly access the camera
and take a picture of your insurance card from within the form attachment field.

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