Before your first session you may like to download the Patient Information Sheet, the Initial Assessment Form and the HIPAA Privacy Information & Confidentiality Form and bring the completed forms with you to the first appointment.
Depending on your symptoms, you may also like to complete the mood inventories. Blank forms will also be available in the waiting room but please 15 minutes before your appointment to give yourself enough time to complete them.
Initial Assessment Questionnaire & General Forms
Please complete all these forms.
Click here to download the Initial Assessment Questionnaire
Click here to download Patient Information Sheet/ Cancellation & Rescheduling Policy
Click here to download HIPAA Privacy of Information Policies Sheet
Depending on your symptoms you may wish to complete these forms.
or if you are pregnant or up to 12 months postpartum complete these forms instead.
Using Medical Insurance Benefits
If you would like me to submit your insurance claim to your insurance company on your behalf please download theInsurance Submission form.
Click here to download the Insurance Submission Form
Click here for more information about using medical insurance benefits
Consent To Communicate With Your Other Healthcare Providers
Please complete the Consent to Release Information Form if you would like me to be able to communicate or release information regarding your therapy to other doctors or for disability records.
Click here to download a Release of Information Consent Form
Credit Card Payment Authorization
If you would like to authorize session payments using your credit or debit card, please download this form and fax the completed form to 847 562-9352.
Click here to download a Credit Card Payment Authorization Form