New Client Paperwork
Please complete the required forms before your first appointment.
Important: Please print and complete all required paperwork and bring it with you to your first appointment. If you have any questions about the forms, please contact us at 815-277-1092 or mentaledgecounseling@gmail.com.
Client Information Form
Basic personal and contact information
Signature Page
Required signatures and acknowledgments
New Client Intake Screening
Initial assessment and screening questions
Release of Information
Authorization for information sharing
Credit Card Authorization
Payment method authorization
Insurance Information
Insurance details and verification
Privacy Practices Signature
HIPAA privacy notice acknowledgment
Need Help?
If you have any questions about completing these forms, please don't hesitate to contact us.
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