Individual/Couples Counseling

Marie Murad-Feldman M.A., LCPC


1742 West Diversey #​3
Chicago IL, 60614
773-230-0902
​refeldma@gmail.com

Client Forms

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