If you are a new patient, please click the link to fill out the following form. This form is web-based, so it is not necessary to print it out. Simply fill out all the information and then click 'Submit' at the bottom. The form will be encrypted and securely sent to our practice via encrypted email.
The following forms may also be useful, but are PDF forms that must but be printed and signed. These may be brought with you to your first appointment or faxed to the office at 217-546-3184.
- PSCI Notice of Privacy Practices (this is for your informational purposes only, and does not need to be returned to the office)
- PSCI Informed Consent for Treatment
- PSCI Informed Consent for In-Person Treatment During COVID-19
- PSCI Informed Consent for Teletherapy Services
If you would like your psychologist to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), please complete this form to authorize the release of psychotherapy information:
Note: To download Adobe Acrobat Reader for free, click here.