Patient Forms
New patients are required to fill out several forms before therapy can begin. To make the process as smooth and efficient as possible, we provide the most important documents as downloads right here on our website.
Please download, complete and bring the following forms to your first scheduled session:
- Patient Registration Form
- Informed Consent for Psychotherapy for Your Therapist
- Notice of Privacy Practices
- Notice of Privacy Practices Consent Form
- Financial Policy
If you are unsure which forms to fill out, don't hesitate to contact us.
For your convenience, we also provide the additional forms as downloads:
- Authorization to Release Confidential Information
- Agreement for Parents
- Feedback Questionnaire
Intake/Initial Session Forms
PSC Consent to Privacy Practices.pdf
Adobe Acrobat document [356.0 KB]
Additional Forms
PSC Authorization to Release Confidentia[...]
Adobe Acrobat document [93.1 KB]
Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.
Where to Find Us:
1300 W. Belmont Ave.
Suite 400E
Chicago, IL 60657
Office Hours
Monday: 8:00 a.m. - 2:30 p.m.
Tuesday: 5:00 p.m. - 9:00 p.m.
Wednesday: 8:00 a.m. - 2:30 p.m.
Thursday: 4:00 p.m. - 9:00 p.m.
Friday: 8:00 a.m.. - 2:30 p.m.
If you are unable to keep your appointment, please cancel your scheduled appointment at least 24 hours in advance.
Patient Forms
New patient? Save time and reduce the amount of paperwork you have to fill out at your first visit. We provide several patient forms as PDF downloads on our site. Please click on the Forms tab in the left hand column above.
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