Susan M. Stasek, PsyD

Therapy for adults & couples
on the North Shore

847-732-6027

the calm after the storm

Envision Psychological Services

Forms to Read,  Download, Complete and
Bring to Your First Appointment

Adult Information Intake Form ~​

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All the facts needed to provide the best care 

Patient Data and Insurance Form ~   

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Everything needed to bill your insurance

Financial and Treatment Policies  ~   

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Includes policies about paying for missed appointments,not billing, using insurance, late cancellations, etc

​Informed Consent  ~   

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Includes information about risks and benefits, emergencies, limits of confidentiality and duty to warm, release of information and disposition of client files, etc.