New Client Forms

 

ONLY COMPLETE IF YOU’VE BEEN SCHEDULED FOR COUNSELING. OTHERWISE CALL OR EMAIL FOR AN APPOINTMENT.

Please complete the 3 following steps within 48 hours in order to hold your appointment slot. Your clinician needs time to review these docs before you meet. Without receiving this completed paperwork we, unfortunately, will not be able to hold your first appointment. Please let us know if you have questions.

Please complete all 3 steps:

1

(A) Demographic and (B) Bio Info

We’d like to get to know you! Please complete (A) the demographic and (B) the biography information, using the below link, to the clinician that you’ll be working: (Estimated time 10 mins)

  • Reed Allen

  • Anthony Borchardt

  • Sandra Buecker Spears

  • Chris Edwards

  • Kirsten Hall

  • Brian Howard

  • Ilene Kastel

  • Esther Kim

  • Anne Leiter

  • Shannon Lieberman

  • Keirstin Lincoln

  • Kelsey Manzi

  • Beth Melewski

  • Corie (Rodeman) Carson

2

Know Your Insurance Benefits

Check your mental health benefits as a safeguard from financial surprises. We’ll check your benefits but on rare occasions we’re not provided 100% up to date information from your carrier. Please call the customer service number on the back of your insurance card and verify what your “mental health benefits are for an office visit” as well as for telehealth counseling. You’ll be told what your deductible, copay and/or coinsurance per session are.

Terms to know:
Deductible – is the amount of money your plan requires you to pay out of pocket first before your insurance coverage kicks in. Most plans have either a copay or co-insurance.
Copay – the flat amount you owe after you meet your deductible.
Co-insurance – the percent that you owe per service after meeting your deductible.
3

Consent Forms to work together:

Please read and complete the below consent for therapy form. This document explains the risk and benefits to counseling, confidentiality, HIPAA and privacy, using insurance, financial agreements, cancellation policies, and a few biographical questions about you that’s helpful in our work together.

If you have trouble, you may contact our Office Manager Zoë Engling for assistance via email or phone  at 312-796-9507

Adobe Flash Player must be enabled on your computer for the dropdown menus on the form to work. Note – there isn’t a “save” option. If you can’t complete it in one sitting, there is a workaround, you can copy and save the URL to use when you’re ready to resume working. If the form won’t submit then you missed a required entry on the form.