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Client Information Form

 

Authorization to Release and/or Receive Information

 

Provider Advance Notice To Insurance Beneficiary of Mental Health Benefits

 

Excused Absence Note

 

Declination of Mental Health Benefit

 

Rescission of Declination of Mental Health Benefit

 

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NICA General Brochure

 

PMS General Brochure

 

Testing for Professionals

 

Then, Today, Tomorrow

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The material presented within this website is informational only and is not intended as a substitute for professional services and assistance. We have endeavored to present accurate information, but cannot guarantee that the information on these web pages is always current or correct. We do not assume responsibility for any consequences that may result from using this web page or any sites. We do not necessarily endorse or support the contents, claims, or representations of the websites we provide links to, in whole or in part. While we try to respond to inquiries, we are unable to offer professional advice via email. If you require urgent care, contact Northern Illinois Counseling Associates, P.C. (NICA) at 815-455-6736 or email us at info@nicapc.com to schedule an appointment. If you require emergency care, contact 911 or go the emergency center of your local hospital.

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