Instructions for New Patients

Please complete forms 1-5 and return them via email no later than 48 hours before your first appointment.

1. Patient information and billing form
2. Privacy and confidentiality agreement
3. Authorization for electronic communication
4. Authorization for telehealth and/or in-person sessions
5. BPA provider-patient service agreement for all clinical staff

If you plan to use your insurance, please bring your insurance card and a photo ID.

We look forward to meeting you!

Call (847) 303-1880 if you have any questions.

• Notice of privacy practices
• Introduction to the No Surprises Act (NSA)