Forms

Notice regarding children age 12 and older:
Children who are 12 and older must sign a release of information for the therapist to speak with their parents about psychotherapy. In Illinois, the right to privacy for mental health records begins at age 12, so, children 12 and older must sign a release of information in order for PSC to release their medical records to any third party, including their parents. Parents of children also have a right to confidentiality.

Form Number	Download and fill out at home	Fill out form at home
1	Informed Consent for Counseling Services (10 pages)	Please read prior to beginning treatment
2	Client Information and Consent (5 pages)	We need original copy signed
3	Release of information	We need original copy signed
4	Adult developmental history (in process of updating)	Coming Soon!!!!!
5	Adult and Teen basic symptom & problem checklists
6	Adult Bipolar Disorder Screening Questionnaire
7	Adult Pre-Therapy Screening
8	Adult Comprehensive Assessment
9	Marital assessment
10	OCD Assessment
11	Child Screening Checklist
12	Child Development History Form	Coming Soon!!!!!
13	Childhood Anxiety Specific Screening Form
14	Cigna EAP Form	We need signed original
15	Magellan EAP Form	We need signed original
16	Magellan EAP Form – USPS Employees	We need signed originals
17	Horizon Healthcare EAP	Coming Soon!!!!!
18	Horizon Healthcare Rights and Responsibilities	Coming Soon!!!!!
19	Ceridian EAP (Lifeworks)	Coming Soon!!!!!
20	Employees Resource Systems (ERS) EAP	Coming Soon!!!!!
21	Primary Care Physician notice (HMO Plans ONLY!!!)	We need signed originals
22	Informed Consent for a Free Consultation Form	We need signed originals