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 hvaughn@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

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 a third party, please fill out the Release of Confidential Information Form below and bring to your next appointment.  

• Release of Confidential Information

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