Privacy and Forms
At the Depression and Anxiety Specialty Clinic of Chicago, protecting the confidentiality of our patients is a very high priority. We invite you to view our privacy policies and other clinic information contained in the documents below. When you do schedule an appointment, it will make your first visit go as smoothly and efficiently as possible if you take a few moments to download and print the forms below.
Click Here to download a .pdf version of our Intake Packet. Please take a moment to print out a copy of this form, fill it out, and bring it to your first session. It provides us with valuable information about what you need and how we might be able to help so we can have the most productive and efficient first visit.
Click Here to download a .pdf version of our Release of Information form. If you have any other doctors or treatment providers with whom you would like us to communicate, fill out the top portion of the first page and sign the second page.
Click Here to download a .pdf version of our Telehealth Agreement. Please fill this out and return it before your first telehealth session.
Click Here for our HIPAA privacy statement. This document is for your personal reference only. Do not print this form out to bring to the clinic.
All completed forms can be returned to us using this secure upload link.
The application is available for download in Portable Document Format (PDF). You will need Adobe Acrobat Reader® to view or print these files.
If Acrobat Reader is not already installed on your computer, click on the icon below for a free download. Then follow the instructions to install the program.