PRIMARY CARE PSYCHOLOGY ASSOCIATES, LLC
  • Home
  • About Us
    • Primary Care Psychology
    • COVID-19 Preparedness and Response
  • Locations
    • Chicago (Lakeview)
    • Chicago (Streeterville)
    • Vernon Hills at Pediatric Partners
    • Winnetka at Elm Street Pediatrics
    • Highland Park at Pediatric Partners
    • Wheaton at Wheaton Pediatrics
    • Batavia at Wheaton Pediatrics
    • Northbrook
  • Our Services
    • Individual Therapy
    • Child/Adolescent Therapy
    • Family Therapy
    • Couples Therapy
    • Diagnostic Testing
  • Our Team
    • Adult Therapists
    • Pediatric Therapists
    • Administrative Staff
  • For Physicians
    • Integration With PCPA
  • Blog
    • What is CBT?
    • Behavioral Chronic Pain Management
    • ​Parent-Child Interaction Therapy
    • Coping with Change
    • Assessment and Behavioral Management for ADHD and Disruptive Behavior Disorders
    • Prolonged Exposure Therapy for Traumatic Stress
    • Substance Misuse and its Behavioral Management
    • Grief
    • Habit Reversal Training (HRT)
    • Behavioral Weight Management
    • Relationship Problems & Communication Management
  • Patient Resources
    • Insurance Information
    • Forms/Paperwork
    • Community Partners
    • External Resources
  • Training and Career Opportunities
    • Doctoral Internship
    • Post-Doctoral Fellowship
    • CLINICAL EXTERNSHIP / ADVANCED PRACTICUM
  • Contact Us

Forms/Paperwork


All new patients need to complete an intake form prior to their first visit. Please follow the links below to PCPA's Adult and Child/Adolescent Intake forms. Forms can be received through e-mail (Please save the file to your device, edit and email to intake@pcpachicago.com), printed and delivered to your first appointment, or faxed to 847-686-0090. 
  • Adult Patient Intake Form
  • Child and Adolescent Patient Intake Form

If you are attending psychotherapy via telehealth, please complete the following consent form prior to your first in-person visit and email it back to intake@pcpachicago.com.  
  •  PCPA Telepsychology Consent Form 

Prior to your first appointment, please kindly review PCPA's Privacy forms by following the link below: 
  • ​HIPAA Notice Form - Protection of Privacy

If you would like for your therapist at PCPA to communicate on your behalf with your primary or specialty care physician, or another third party, please fill out the Release of Confidential Information Form below and bring to your next appointment.  

  • Release of Confidential Information

If you are attending psychotherapy in person during the COVID-19 crisis, please complete the following consent form prior to your first in-person visit and email it back to intake@pcpachicago.com.  
  • Informed Consent for resuming in-person sessions

About

Services

Locations

Providers

Insurance

Contact

Integration with PCPA

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"Cutting Edge Integration of Behavioral Health & Medicine"

Primary Care Psychology Associates, LLC
Phone & Fax: (847) 686-0090
admin@pcpachicago.com

Copyright © 2020
  • Home
  • About Us
    • Primary Care Psychology
    • COVID-19 Preparedness and Response
  • Locations
    • Chicago (Lakeview)
    • Chicago (Streeterville)
    • Vernon Hills at Pediatric Partners
    • Winnetka at Elm Street Pediatrics
    • Highland Park at Pediatric Partners
    • Wheaton at Wheaton Pediatrics
    • Batavia at Wheaton Pediatrics
    • Northbrook
  • Our Services
    • Individual Therapy
    • Child/Adolescent Therapy
    • Family Therapy
    • Couples Therapy
    • Diagnostic Testing
  • Our Team
    • Adult Therapists
    • Pediatric Therapists
    • Administrative Staff
  • For Physicians
    • Integration With PCPA
  • Blog
    • What is CBT?
    • Behavioral Chronic Pain Management
    • ​Parent-Child Interaction Therapy
    • Coping with Change
    • Assessment and Behavioral Management for ADHD and Disruptive Behavior Disorders
    • Prolonged Exposure Therapy for Traumatic Stress
    • Substance Misuse and its Behavioral Management
    • Grief
    • Habit Reversal Training (HRT)
    • Behavioral Weight Management
    • Relationship Problems & Communication Management
  • Patient Resources
    • Insurance Information
    • Forms/Paperwork
    • Community Partners
    • External Resources
  • Training and Career Opportunities
    • Doctoral Internship
    • Post-Doctoral Fellowship
    • CLINICAL EXTERNSHIP / ADVANCED PRACTICUM
  • Contact Us