Forms

Please click on the links to download and email the completed forms to Debra@positivereframe.org.

Only share information electronically if you feel safe to do so. I recommend ensuring your personal privacy settings on your electronic devices as well as using a virtual private network (VPN).

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Feel free to call me at 847-603-4677 or email me with any questions or concerns.

FORMS

FOR MINORS

“Any minor 12 years of age or older may request and receive counseling services or psychotherapy on an outpatient basis without the consent of the minor’s parent or guardian. Outpatient counseling or psychotherapy provided to a minor under the age of 17 shall be limited to not more than 5 sessions, a session lasting not more than 45 minutes, until the consent of the minor’s parent or guardian is obtained.  The minor’s parents shall not be informed without the consent of the minor unless the facility director believes such disclosure is necessary.  The minor’s parent or guardian is not liable for the costs of the outpatient counseling or psychotherapy.“

Section 405 ILCS 5/ of Mental Health and Developmental Disabilities Code

EMERGENCY

If you are experiencing a mental health emergency, please call 911 or visit your local emergency room.