Forms

Notice of Privacy Practices

This document details the right to privacy that you have under the law. These rights are applicable to any medical or therapeutic setting under federal HIPPA standards. It is the policy of the PDG to always obtain informed consent from our clients before involving another party except in some legally mandated reporting situations. We will always attempt to keep our clients informed. It's yours to keep and cherish; suitable for framing.

Treatment Agreement

This document outlines the PDG policies regarding services, fees, missed appointments, and general office policies. Please let us know if you have any questions about these statements. There are spaces to print the client's name at the top and to sign at the bottom to accept these policies. No fine print; no surprises.

Intake Information

At the top is your basic contact information. In the middle is your insurance information. If you are using insurance, you may need to contact them to obtain some of this information. The insurance company phone number is frequently found on the back of your card and may be referred to as the "MH/SA" number(mental health/substance abuse). They will tell you if you need to precertify for your appointment and what your financial obligations might be. At the bottom of the page is a space to tell us about how you found the PDG and what you would like to address during your appointment.

Click icon below to view or download

Get ahead of the paper work

This page contains the forms that PDG clients are asked to complete before their first session. They are provided here so that you may copy or download them before arriving at your first appointment. This allows more time to be spent addressing your concerns and less time needing to be spent on paperwork. There are 3 basic forms available.

D e v e l o p m e n t G r o u p

T h e P e r s o n a l

PD G

The Personal Development Group is an experienced staff of psychologists and counselors who offer a whole person approach to psychotherapy, counseling, training for business management, and seminars for therapy professionals. Seminar information is available for anger management, workplace ethics, diversity training, emotional management, and increasing your emotional IQ. Psychotherapy and counseling are available for stress, ADD, bipolar disorder, depression, anxiety, marital and relationship issues. EMDR and family treatment are offered. Tambien terapia en Espanol. Chicago area locations for the PDG include: Lincoln Park 60610, Lakeview 60613, and Evanston 60201.