Instructions for New Patients

Please complete forms 1-5 and bring them to 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)