Behavioral Psychology Associates
(847) 303-1880
Behavioral Psychology

Instructions for Our New Patients

Welcome to our practice. We have all of our new patient forms on this website so that you can complete them before your first appointment and bring them with you to the appointment.

The Psychotherapist-Patient Services Agreement is for your records. It describes our services and some expectations regarding treatment. You may want to print it out and keep a copy for your records, but it will also continue to be available on our website.

The Patient Information and Billing Form includes three pages. You will need to print out and complete these three pages.

Please be sure to complete the signatures on the second and third pages. All patients aged 12 and up must sign the second page of this form. If the patient is a child (below the age of 18), the parent must also sign the form. All signatures must be witnessed. The witness should be an adult who can verify that he or she saw the form signed. A witness can be your spouse, the child’s other parent, an adult child, a neighbor or coworker, etc. Remember to bring these three pages with you to the first appointment.

Finally, if you are a BPA patient and will have us submit claims to your insurance company, bring your insurance card and a photo ID.

We look forward to helping you resolve your problems.

Forms for Download

Psychotherapist-Patient Services Agreement

Patient Information and Billing Form

 

Our Notice of Privacy Practices is also available on this website. Please feel free to print this out for your records. If you prefer, you may ask for one at your appointment.

Behavioral Psychology