Privacy and Forms

At the Depression and Anxiety Specialty Clinic of Chicago, protecting the confidentiality of our clients is a very high priority.  We invite you to view our privacy policies and other clinic information contained in the documents linked on this page. 

When you schedule an initial appointment at DASC, our dedicated intake team at will send you a link to set up your secure client portal. Once you have done so, you will be asked to complete DASC’s intake paperwork using this secure electronic client portal. We ask that you submit the completed intake paperwork at least 24 business hours prior to your first session time, so that our team has enough time to review it.

If you would prefer not to set up an electronic client portal, you can download the paperwork via the attachments here, and submit it once completed to the secure upload link below. Our intake team is happy to answer any questions about this process at (773) 494-5505.

• Click Here to download a .pdf version of our Intake Forms. These intake forms provide 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.