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Licensed Clinical Professional Councelor

A Chicago Counseling Practice.... Help for Professional Women like You

Forms

Please click the links below to download the forms.

Forms for Your First Visit:

Client Information Form

Informed Consent

Initial Visit Form

Privacy Form (HIPPA)

Additional Forms:

Release of Information Form

Credit Card Authorization Form

As your therapist, my commitment to you is to help you make lasting, permanent improvements to you life. Sometimes this may not be easy, but I promise to be there to support and guide you through them until you achieve the goals that you want.

Let’s Connect

Stacy Perkins, LCPC
(312) 810-0707
stacyperkinslcpc@gmail.com

G I V m R

On the Blog

  • How to Make New Year’s Resolutions that Follow You Through the Year
  • How to Choose the Right Therapist
  • These 5 Signs Can Tell You If You Need to Seek Counseling
  • What’s your ‘Mental Load?’
  • Cheating’s Lasting Effects

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