Intake Forms

If you're a first-time client, please review and complete the following forms, bring them to your first session:

  • Insurance Verification Form (We encourage every patient/guardian to check benefits prior to their intake)
  • History form appropriate for the age group of the patient
  • Assessment or Therapy Consent Forms

 

Therapy Consent Forms Insurance Verification Form
Assessment Consent Forms Consent for Release of Information
Child History Form Child Treatment Contract
Adolescent History Form  
Adult History Form  
   
   

 

Note: To download Adobe Acrobat Reader for free, click here .

 

Northwest Behavioral Health Services, PC

415 W. Golf Rd,
Arlington Heights, IL 60005

Contact Us Today

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Please do not submit any Protected Health Information (PHI).

Front Office Hours of Operation

Monday  

9:00 am - 4:00 pm

Tuesday  

9:00 am - 4:00 pm

Wednesday  

9:00 am - 4:00 pm

Thursday  

9:00 am - 4:00 pm

Friday  

9:00 am - 4:00 pm

Saturday  

Closed

Sunday  

Closed

  • 415 W. Golf Rd,
    Arlington Heights, IL 60005