Intake Forms

Please select a form to view or download it.  

Adult Demographic Form

Child Demographic Form

Informed Consent Form

Notice of Privacy Practices

Credit Card Authorization Form

Get in Touch

Phone: (224) 225-9977

1590 North Rand Road Suite 202
Palatine, Illinois 60074

Get in Touch

Phone: (224) 225-9977

1590 North Rand Road Suite 202
Palatine, Illinois 60074