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Forms

  1. Credit Card Authorization Form
  2. Informed Consent for Telepsychology
  3. Consent for Returning to In-Person Psychological Services
  4. Child Therapy Contract
  5. Illinois Notice Form
  6. Consent to Release of Information
  7. New Client Information
  8. Consent for Treatment – Michelle Chaban, Psy.D.
  9. Consent for Treatment – Will Fisher, LCPC, M.Div
  10. Consent for Treatment – Samantha Fox, Psy.D.
  11. Consent for Treatment – Shama Joshi, LCSW
  12. Consent for Treatment – Erin Lipin, LCSW
  13. Consent for Treatment – Carey Rand, LCSW
  14. Consent for Treatment – Cindy Templer, Psy.D.
  15. Consent for Treatment – Allison Yambor, LCSW
  16. Consent for Treatment – Megan Ray, LCPC
  17. Consent for Treatment – Alicia Rogers, LCSW
  18. Consent for Treatment – Kimi Simms, LCSW
  19. Consent for Treatment – Udisha Bhadury, LPC
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