• Home
  • About
    • Robert J. Smith, MSW, LCSW
  • Services
    • Clinical Hypnosis
    • Mental Health Counseling
    • Marriage Counseling
    • Telehealth Counseling
    • Work With Medical Conditions
  • Testimonials
    • Leave A Review!
  • Rates
  • Forms
  • Resources
    • Blog
    • Newsletters
    • EBook
  • Contact
  • (847) 363-5845
  • Smith Psychotherapy Solutions

FORMS

Contact

Client Information Form

View Form

Office Policies

View Form

Release of Information Form

View Form

HIPPA Notice of Privacy Practices

View Form

Authorization to Use or Disclose information for Treatment, Payment, and Health Care Operations (TPO)

View Form

Credit Card Authorization Form

View Form

Tele-Mental Health Form

View Form


Copyright © 2023 Smith Psychotherapy Solutions, all rights reserved.
500 Lake Cook Road, Suite 350,  Deerfield, IL 60015   (847) 363-5845
  • Home
  • About
    • Robert J. Smith, MSW, LCSW
  • Services
    • Clinical Hypnosis
    • Mental Health Counseling
    • Marriage Counseling
    • Telehealth Counseling
    • Work With Medical Conditions
  • Testimonials
    • Leave A Review!
  • Rates
  • Forms
  • Resources
    • Blog
    • Newsletters
    • EBook
  • Contact