Patient Information

All new patients are required to fill out a patient information packet before their appointment can be scheduled. This packet also contains detailed information for the patient on what to expect before and after your visit, as well as the fee schedule for the visit.  We request that you include all pertinent testing you have had within the last year along with your patient information packet. Once our office receives this information packet, we will schedule an appointment and instruct you how to proceed with necessary bloodwork and tissue testing prior to this scheduled appointment.

Please download and fill out the packet, and then send it (along with a copy—front and back—of your insurance card) into the office via
fax: (504) 818-0492
– or –
mail: 3001 Division St., Suite 203, Metairie, LA 70002
Because the form contains sensitive information, we do not recommend emailing it.

Click here to download a New Patient Packet

Click here to download a New Patient Child Packet

Supplement Reorder Requests
(Applies for all R3 Members)

Prescription Refill Request
(Only for patients of Dr. Rai)

Request a Letter