The Psychology Center, Inc
10343 S Western Avenue
Chicago, IL 60643
General Office Telephone (24 hours) 773/238-2828
New Client Intake Forms
FORMS - (can
completed ahead of time for
be a new
already scheduled your first
find it convenient to
print out a
copy of the following "new
and complete them
Then you can mail
REQUIRED FORMS for first session:
REQUIRED FORMS for second session:
OPTIONAL FORMS to be completed anytime
INSURANCE ID CARDS:
To reduce your costs as much as possible, it is very important that you bring your insurance plan ID card(s) with you for us to enlarge and photocopy (both sides), OR you can send them to us ahead of time to help us determine your coverage benefits, co-pays, etc. (Enlarge and photocopy both sides so the information comes out clearly). If your insurance plan sent you a letter or treatment authorization form, bring that with you too for us to copy.
The Psychology Center, Inc is in-network with just about every health insurance plan there is, so we will work with your plan to get you the lowest cost possible for your visits. Most clients pay LESS THAN $30 co-pay per visit, but this may vary according to the plan you have selected. Your co-payments should be made at each session.
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