If you are a new client, please complete the following forms. We will need signed copies for your first session.
It is also helpful for us to have copies prior to your first session, so if you have the ability please fax them back to us at 1(847)749-3807.
- Intake Form (Completed by each client in treatment)
- Universal Consent Form (Completed by each client in treatment)
- HIPPA/Privacy Practices (For you to keep)
- Financial Assistance Brochure (For you to keep)
Occasionally, we would like to coordinate care with your other providers (for example, your psychiatrist, primary care physician, etc..)
Please, review this form to authorize release of psychotherapy information. It is the standard form we use, and we provide it here so that you may review it at your own pace.
This form is designed to help you gain a clear understanding of your insurance benefits. We reccomend that you use this form prior to scheduling your first sesion, unless you are a self-paying client.
Note: To download Adobe Acrobat Reader for free, click here.