Client Forms – Get a Quick Start

To have your insurance benefits verified before your first session, download the Client Intake form and submit it to us by fax,  (708) 515-4471.

Client Intake

The following forms will complete all intake needs. Please, download, review and, if you’re ready, sign. Bring them to your first appointment and we can spend more time with you.

Consent for Treatment

Fee Disclosure and Payment Policy

HIPPA Privacy Policy   – (This is your copy; no need to bring it with you)

Authorization for Release of Information – If you would like your therapist to coordinate care with another provider (for example, your psychiatrist, primary care physician, child or adolescent’s school etc.), complete this form to authorize release of specific information.