Prior to your initial appointment, please download the New Client Forms file below, complete the forms and bring them to your appointment. That way we can get going with therapy instead of completing forms at the beginning of the appointment. Or you can email them to me at [email protected]. You are also welcome to mail the forms to my office ahead of your appointment. Send them to my attention at 600 N. North Court, Suite 150, Palatine, IL, 60067.
The first file, Practice Policies & HIPAA, will give you specific information about my practice and therapy as well as vital HIPAA information to let you know your rights on the privacy of your child's and/or your personal health information. Please read through this information before your appointment. This document is yours to keep.
The second file, New Client Forms, includes all the paperwork to complete before your initial session. Here you will find the Signature Form for you to consent to treatment for yourself and/or your teen (If your child is age 12 or older, please have him/her sign the consent form as well), the Client Information Form to provide basic demographic information about yourself and/or your child. You will also find the Late Cancellation and Missed Appointment Policy as well as the Authorization to Charge Credit/Debit Card. The Counseling History Form will give me info about your needs and goals for therapy and any previous counseling experience that you or your child have had. And finally, The Symptom Checklist, helps me to focus on the things that you or your teen are struggling with. If you have a teen, please have them fill out a copy too. Or if you are seeking couple's therapy, I ask that both you and your spouse each fill out a copy.
I will be happy to answer any questions at your appointment or before if you wish. I look forward to meeting you for the first time!I
The first file, Practice Policies & HIPAA, will give you specific information about my practice and therapy as well as vital HIPAA information to let you know your rights on the privacy of your child's and/or your personal health information. Please read through this information before your appointment. This document is yours to keep.
The second file, New Client Forms, includes all the paperwork to complete before your initial session. Here you will find the Signature Form for you to consent to treatment for yourself and/or your teen (If your child is age 12 or older, please have him/her sign the consent form as well), the Client Information Form to provide basic demographic information about yourself and/or your child. You will also find the Late Cancellation and Missed Appointment Policy as well as the Authorization to Charge Credit/Debit Card. The Counseling History Form will give me info about your needs and goals for therapy and any previous counseling experience that you or your child have had. And finally, The Symptom Checklist, helps me to focus on the things that you or your teen are struggling with. If you have a teen, please have them fill out a copy too. Or if you are seeking couple's therapy, I ask that both you and your spouse each fill out a copy.
I will be happy to answer any questions at your appointment or before if you wish. I look forward to meeting you for the first time!I
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