Couples Forms

Everyone seeking services at North Shore Counseling is required to have necessary paperwork on file. Because billing can be complicated for couples counseling, we offer a detailed explanation of billing options here:

Regardless of how you choose to bill, everyone is required to have the following forms on file.

Required Forms for Couples

  1. Intake Cover Page for Adults – each partner needs to complete this form.
  2. Billing Procedures for Couples — REQUIRED
  3. Insurance Declaration Form – each partner needs to complete this form.
  4. Contract for Services – both partners can sign one contract.
  5. Privacy Policy – both partners can sign one privacy policy.
  6. Marriage Assessment Tool – each partner needs to complete this form.

If you have any questions about these forms, contact your counselor. Complete these forms prior to your first appointment, and upload them below. Alternatively fax them no later than 24-hours prior to your appointment to (847) 205-0377, or you may bring them with.

Once completed scan and upload the forms here…

[contact-form-7 id=”961″ title=”Upload Reg Packet Couples”]

(Acceptable file formats .pdf .png .jpg .jpeg, 5M limit. Repeat upload process for additional files.)