Skip to content

Forms

Park Ridge Psychological Services provides the following forms for your convenience. Please download, print and fill out the appropriate form out prior to your appointment so that pertinent information (such as insurance coverage, personal information, et al) is already taken care of before your first session.

The following forms are available in both Adobe Portable Document Format (PDF) and Microsoft Word document format:

FORMPDF
Initial Information Intake Form
629kb
Informed Consent to Treatment/Evaluation**
688kb
Notice of Privacy Practices
81k
Acknowledgement of Receipt of Privacy Notice
60k
History & Questionnaire
634kb
Release of Information
773kb

**Please complete and submit this information prior to your first visit.

Need Adobe Reader to view/print the PDF download?

Get Adobe Reader