NEW PATIENT FORMS
Understanding the Unique Needs of Your Child
Want to schedule an appointment? We look forward to hearing you. For all new patients, we require the Parent Pack Intake (below) to be filled out and submitted prior to your child’s first appointment. For adult patients, select group attendees and non-therapeutic clients fill out the Patient Intake (below). For your convenience you can fill the forms out online.
CHILD - NEW PATIENT INTAKE FORM
Policies, background Information for new patients.
Help us understand your child’s profile.
ADULT - PATIENT INTAKE FORM
Simple intake forms for adult patients, select group attendees and non-therapeutic clients.
FEEDING THERAPY INTAKE
Additional intake form for feeding therapy clients. This service may be held virtually with our Chicago clinic.
ADULT & ADOLESCENT - PATIENT INTAKE FORM
Intake forms for adult and adolescent patients, BEAM and select group attendees.
ADULT & ADOLESCENT - PROFILE QUESTIONNAIRE
Profile Questions for adults & adolescents patients, BEAM and select group attendees.
PSYCHOTHERAPY INTAKE FORM
Intake forms for Children & Adolescents Receiving Psychotherapy Services
PSYCHOTHERAPY INTAKE FORM FOR PARENTS
Intake forms for Parents receiving Psychotherapy Services
Questionnaire for Children & Adolescents receiving Psychotherapy Services