Patient Forms

Please review, fill out, and sign the patient forms prior to your appointment.

Note: for virtual sessions, please either email or mail your forms prior to your session.

Email: marys@stressdocs.com
Fax: (630) 920-0931
Mail: 501 W. Ogden Avenue, Suite 6
            Hinsdale, IL 60521

Forms for Children

• Patient Information Form
• Child Questionnaire
• HIPPA Notice
  
• Notice of Privacy Practices Acknowledgement
• Patient Agreements and Authorization
• Appointment Reminder Authorization (optional)
• Credit Card Agreement (optional)

Please Include:
Copy of Driver’s License of Authorizing Party (both sides)
Copy of Insurance Card of Responsible Party (both sides)

Forms for Adults

• Patient Information Form
• Adult Questionnaire
• HIPAA Notice
• Notice of Privacy Practices Acknowledgement
• Patient Agreements and Authorization
• Appointment Reminder Authorization (optional)
• Credit Card Agreement (optional)

Please Include:
Copy of Driver’s License of Authorizing Party (both sides)
Copy of Insurance Card of Responsible Party (both sides)

Pandemic Consent Form

• Pandemic Policy and Consent