Make an Appointment: intake@peoplepsych.com | 312-252-5252

Complete Forms Online

Below are links to our secure and HIPAA compliant online forms.  For your convenience, you can complete forms securely through the link to the JotForm.com form site.  All forms completed and submitted to PeoplePsych through the online forms are downloaded securely.  There is no obligation to use the online JotForm version and you can instead opt to download the PDF version via the link provided.  Completed PDF forms, as well as any additional materials, can be emailed to us at:  intake@peoplepsych.com.

Clicking the thumbnail image will take you to an external website for secure HIPAA compliant online form completion and submission.

New Client Forms

There are a few forms that we need every client to complete.

Please submit the completed forms to PeoplePsych prior to your appointment – if you are not using the online format, please fax or email the form directly to your therapist or our centralized address: intake@peoplepsych.com. If you forget to this prior to the appointment, your therapist will simply have you complete the forms prior to starting your session, so no worries!

Also, if you wish to use insurance, please take a picture of the front and back of your insurance card as we like to have a copy on file. Our staff will call and attempt to verify your benefits after the initial session.

Individual Therapy

All intake forms for those seeking individual therapy are completed securing through our HIPAA complaint practice platform: Jane.

Please contact your therapist or our Clinical Coordinator for assistance.

Changing Your Information

If the event that you need to update your address, insurance information or credit card we ask that you complete the needed form below – and give to your therapist – for our records as soon as possible.

And if your insurance is new, please also bring or forward a picture of your new insurance card, along with the completed form, so that we can maintain a copy for our records.

Release of Information (ROI)

If you wish to enable anyone to communicate with your therapist or other PeoplePsych personnel – for clinical or financial reasons – a completed Release of Information (ROI) is required prior to all communication.

COVID-19  In-Person Waiver

Due to the coronavirus global health pandemic, all clients being seen in-office need to complete our Informed Consent for In-Person Sessions. In the event that a client does not wish to comply with the health and safety precautions we have established, sessions will be offered via telehealth. Clients not wishing to comply with health and safety protocols (including wearing a mask) and will not be permitted to participate in-office sessions.

COVID-19 Waiver

No Surprises

Those who are seeking services on a fee-for-service or through their out-of-network insurance benefits must be notified of the costs for services provided by PeoplePsych therapists so that there is no “surprise billing”.  The charges listed herein are the maximum charges per scheduled session. You and your therapist (with the approval of PeoplePsych) may have agreed on a lower discounted rate per session, which is what you will be charged.

No Surprises