At the first appointment, you will be asked to fill out the New Client Intake Forms, Privacy Forms and What To Expect At Your First Appointment Form. These will provide our staff with medical and family history, including any sleep, dietary, injury and other health related issues. We will also assess how the child is coping as well as the parent(s). We would like to get a glimpse into a typical day in the client’s life.
Forms & Brochures
For your convenience, please download all forms and print them. Bring the completed forms to your first visit. You may download them separately, or you may download the entire New Client Packet.
- New Client Packet (required at first visit)
- Client Intake – Secondary Insurance Form
- Client Information Release Consent Form
- Client Authorization for Release of Confidential Health Information
- Privacy Notice
- Informed Consent During COVID-19 Public Health Crisis
- Outpatient Services Agreement for Collaterals
- Consent and Agreement for Psychological Testing and Evaluation
- To download the files, click on the link and a new window will open.
- The document will open in a new window. You will need to have Adobe Acrobat Reader installed on your computer to view the files in PDF Format. (Click here to download the FREE Adobe Reader.)
- Print the PDF file pages, write in your information and bring to your appointment.
You may choose to complete the forms on your computer. However, if you do decide to email your forms to us, please understand that information sent via email may not be confidential. If you email this information, you do so at your own risk. Forms may be sent to [email protected].
To email Agor Behavioral Health Services a completed form:
Open your email program or login to your webmail account (such as Yahoo, Google, etc.).
Attach your completed file as you would any other document. You will need to locate the file on your computer.
24402 W. Lockport Street,
Plainfield, Illinois 60544
Available by Appointment