Policies and Forms

Please review and complete the following forms/documents before coming to your first visit.


Please click to download:
New Patient Registration Packet 2019
Patient Policies 2019
Privacy Practices
Authorization to Release Info PSYDE

In order to treat you most effectively, we prefer to be able to contact certain people who may be important to your care and treatment.

Please complete a separate release of information for for the following persons (if applicable):

Your primary care physician:  Authorization to Release Info PSYDE

Therapist/Counselor you are seeing:  Authorization to Release Info PSYDE

Psychiatrists/Psychiatric facilities (e.g. The Rockford Center) who have treated you in the last seven years:  Authorization to Release Info PSYDE

Any family members you would like to include in your treatment:  Authorization to Release Info PSYDE

(This must be completed if you would like the doctor to meet with your family member during any of your sessions or talk to your family member on the telephone).