Adult Forms

Here are the forms for Adult, Individual clients. If you’re a teen or coming in for couples counseling, click back to the main list to get to the right set of forms.

Please open, print, and complete these forms. Return them by email(, FAX (847-205-0377), or upload through the links below. You can also bring them with you to your first appointment.

Required Forms for Adults

  1. Intake Cover Page for Adults
  2. Insurance Declaration Form
  3. Contract for Services
  4. Privacy Policy
  5. Personal History – print version
  6. Personal History – on-line version
  7. Authorization for Release of Information

If you cannot open these forms, contact your counselor directly to have a set mailed or faxed to you.

[contact-form-7 id=”957″ title=”Upload Reg Packet”]

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