Forms
Please read and/or complete the following forms and return them before your initial visit.
​
-
Office Policies (read-only)
​​
-
HIPAA Illinois Notice Form (read-only)
​​
-
Consent for Assessment and HIPAA Signature Pages: To access all fields, the document must first be saved and opened from the saved file. If parents are divorced, both parents should complete this form. Children 12 and older should also sign this form.
​​
-
Credit Card Information: To access all fields, the document must first be saved and opened from the saved file.
​​
-
Family History Form (to be completed by family)
​​
-
Release of Information: Please complete this form if you would like us to communicate with other individuals involved in your (patients over 18 years old) or your child’s care (patients under 18 years old). To access all fields, the document must first be saved and opened from the saved file. Children 12 and older should also sign this form.