LOCATION


SKOKIE
5225 Old Orchard Rd., Suite 25C
Skokie, IL 60077
phone & fax:

847.972.1070
fax 847.983.4459

e-mail:

drbeth@familiesintransition.info
Forms

forms

Prior to your first session with one of our clinicians, you will be asked to complete some paperwork that becomes part of your permanent file. Below are the forms you will need to complete, and information on our privacy policies required by HIPAA. Hard copies of these documents are available at the Skokie office upon request.

Before attending your first appointment, all clients should complete the “Client Information Sheet” and the “Privacy Agreement” documents, and bring them with you to your first appointment. In addition to those forms, if you are a therapy client, please review the HIPAA documents and bring a signed copy of the signature pages for the “HIPAA Notice of Privacy” document, and the “HIPAA Psychotherapy Agreement” document. We are required by law to keep the signed signature pages in your file. If you are a mediation client, please review the “Mediation Agreement” document so we can discuss it at our first meeting, at which time you will be asked to sign it. If you are a Parenting Coordination client, please review the “Parenting Coordination Agreement” form, so we can discuss it at our first meeting, at which time you will be asked to sign it. Any Questions?? Feel free to email Dr. Wilner for clarification regarding which forms you need to complete.

© 2012 Families in Transition, Inc.