Forms

Please click in link to download, read and complete Client Information Sheet before first visit. I will review and answer any questions before signing forms.

Disclosure Statement and Informed Consent Form

Therapy Disclosure Statement IL

Client Information Sheet Form

clt info form

“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

Parent/Guardian Disclosure Form

minor.parent disclosure

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