1742 West Diversey #3Chicago IL, 60614773-230-0902refeldma@gmail.com
First time clients please complete the forms below prior to attending your first session. If you have any questions regarding these forms please don't hesitate to contact me.
CLIENT FEE AGREEMENT.pdf
CLIENT_ASSESSMENT.pdf
CONSENT TO SERVICES.pdf
COUPLES ASSESSMENT.pdf
HIPAA.pdf
INSURANCE AUTHORIZATION.pdf
RECEIPT OF PRIVACY NOTICE.pdf