Client Forms

Your therapist will send you a link to complete the Intake Forms online. However, if you would prefer to view or complete a fillable, PDF version of these forms, download the links below.

Required Forms:

• Client Intake Form
• Client Service Agreement
• Privacy Practices
• Consent to Treatment
• Insurance Considerations (for clients using insurance)
• Good Faith Estimates (for clients who do not have or who are not using insurance)

Optional Forms: (your therapist will indicate if these forms are being requested)

• Client History
• Client's Guide to Verifying Insurance (for clients using insurance)
• Telehealth Consent (for clients doing teletherapy)

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Please limit information provided to contact information only as this form is not deemed secure. You acknowledge and accept the risks of this communication. When you set up a session with one of our counselors, we will connect you to our secure and HIPAA compliant portal for entering confidential and Personal Health Information.

Evanston & Chicago, IL