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 Estimate (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. By completing this form, you also agree to receiving a potential phone call and/or voice message if you provide us with a telephone number. 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