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ASSESSMENT SESSION FORMS
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. Blank forms will also be available at the office but please arrive
15 minutes early for your appointment to give yourself enough time to complete them.
If you are using Humana insurance,
please download the forms on the Humana Forms page (see side tab).
Click here to download the Initial Assessment Form
Click here to download the Patient Information Sheet
Click here to download HIPAA Privacy of Information Policies Sheet
If you would
like me to be able to communicate or release information regarding your therapy to other doctors or for disability records,
please download and complete the Consent to Release Information Form.
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
REGULAR SESSION FORMS
These are forms that we have used in our sessions. Please download more copies if you
need them.
Click here to download a Weekly Thought Journal
Click here to download the Postpartum Depression Screening Questionnaire
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