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The Summit Center for Mental Health

The Summit Center for Mental Health
(815) 773-0772
info@thesummitcenter.net
Forms

If you're a first-time client, please print out the following forms, complete them and sign as needed, and bring them to your first appointment. Only ONE Client Intake Form A and ONE Limits of Confidentiality / Cancellation Policy Forms are required for each family. A Client Intake Form B should be filled out for each person that will be attending sessions. For example, a couple would complete one of Client Intake Form A, two of Client Intake Form B, and one of Limits of Confidentiality / Cancellation Policy Forms.

 

 

Adult Client Intake Form A  
Adult Client Intake Form - Spanish  
Adult Client Intake Form B  
Child and Adolescent Intake Form  
Psychiatrist's Check Sheet  

 




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