Helpful Forms

 If you're a new client, please review and complete the following required forms and bring them to your first therapy session.

         Client Psychotherapy Registration Form

          Informed Consent

         Informed Consent for Telehealth Services 

         Changes Counseling HIPAA


If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Authorization to Release Personal Health Information


Note: To download Adobe Acrobat Reader for free, click here.

Rochelle Location

Address

604 N. Main Street,,
PO Box 364,
Rochelle, IL 61068

Phone

815-501-2088

Peru Location

Address

400 5th St.,
Suite 190,
Peru, IL 61354

Phone

815-501-2088

Office Hours

Monday  

9:30 am - 4:30 pm

Tuesday  

9:30 am - 4:30 pm

Wednesday  

9:30 am - 4:30 pm

Thursday  

9:30 am - 4:30 pm

Friday  

9:30 am - 3:30 pm

Saturday  

Appointment Only

Sunday  

Closed