Paperwork

Please click the icon next to the form name to download the form.

Forms to complete or review before a first session:

  • Registration Form (complete)

  • Informed Consent (review)

  • HIPAA (review)

Registration Form

Collects your basic contact and billing information, as well as your contact preferences and signed consent.

Informed Consent

Outlines the potential pros and cons of participating in therapy, as well as my policies about cancelations, contact in between sessions, and social media.

HIPAA Policy

Outlines the measures I take to protect your personal information and describes what personal information will be shared about you electronically.

Release of Information

This form establishes permission for me to speak with another person of your choosing and any limits on what I might share.

COVID Consent

Completion of this form is required for returning to in-person sessions when I make them available.

 

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Contact

Phone: (224) 585-3325

Fax: (224) 585-0910

Address

444 N. Northwest Hwy, Suite 375
Park Ridge, IL 60068

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