Revisions Counseling Services LLC (630)481-6644 Revisionscounseling@gmail.com

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    • Home
    • Menu
      • Services
      • Why Therapy
      • Meet Our Team
      • Online Video Counseling
      • Insurance & Fees
      • Makes Payments
    • Groups & Events
    • Online Video Couseling
    • Resources
      • Helpful Forms
      • Mental Health Resources
      • Medical Health Resources
      • International Resources
    • Common Questions
    • Types Of Therapy
    • Articles & New Letters
    • Helpful Webpages
    • Employment
    • Training Program
  • Home
  • Menu
  • Groups & Events
  • Online Video Couseling
  • Resources
  • Common Questions
  • Types Of Therapy
  • Articles & New Letters
  • Helpful Webpages
  • Employment
  • Training Program

Medical Release Form

To coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this the Authorizations Discloser Form to authorize release of psychotherapy information:

Authorization to Disclose Information Form (pdf)Download

Intake & Confidentiality Forms

If you're a new client, please complete the following forms and bring them to your first therapy session. 

Limits of Confidentiality:Therapy Cancellation Policy (pdf)Download
Service Intake Consent For Treatment (docx)Download

Insurance Form

Insurance form for clients to fill out and complete:

Insurance Form (pdf)Download

Copyright © 2019 Revisions Counseling  Services LLC - All Rights Reserved.

  • Home
  • Meet Our Team
  • Common Questions
  • Helpful Webpages
  • Employment
  • Training Program