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 ~​

All the facts needed to provide the best care 

Patient Data and Insurance Form ~   

Everything needed to bill your insurance

Financial and Treatment Policies  ~   

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

Informed Consent  ~   

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

Psychological Services conveniently located in Delany Chiropractic and Wellness Center
for individuals and couples in Gurnee, Grayslake, Glenview, Libertyville, Lake Forest,​
Highland Park, Lake Bluff, ​​Lake Villa, Wadsworth, Waukegan and other locations in Lake and McHenry Counties in  Illinois​​​, and South East Wisconsin.

Copyright  2013 Susan M. Stasek, PsyD ~ All Rights Reserved