Southern Illinois Institute of Behavioral Health, PC

Assessment for adults as well as therapy for Children, Adolescents, Adults, Couples and Families

New Client Forms

If you are a new therapy client, or are considering treatment at our office, please read and complete the following forms and bring them to your first therapy session. By doing this, you will significantly reduce the amount of paperwork required in this initial meeting and thus, allow us to concentrate on your primary concerns. It also allows you to fully read through the information provided to you and to ask questions about this information at your appointment.

If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Client Registration eForm Request

This form is to request a Client Registration eForm which will then be sent to your provided email address for you to fill out and return.

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

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Southern Illinois Institute of Behavioral Health
P 618.710.4123
F 618.731.4082
9 Junction Dr W, Suite 3
Glen Carbon, Illinois 62034
[email protected]