Resources | Clinical Center | SIU

NOTE: Adobe Reader is required to view and print our manuals and to also sign our forms. If you do not have Adobe Reader, you may download a free copy HERE. 

Install Adobe Acrobat Reader for Windows 10, click HERE.
Install Adobe Acrobat Reader for Mac OS, click HERE.
Create a Digital Signature (Digital ID), click HERE.
 

Registration Forms:

• HIPAA (Fillable PDF)
• Medicaid Waiver (Fillable PDF)
• Consent to Electronic Communications (Fillable PDF)

Intake Forms:

• Informed Consent to Record (Filliable PDF)
• Information and Consent for Treatment (Fillable PDF)
• Informed consent regarding use of telehealth  (Fillable PDF)

Documents and Forms:

• Informed Consent to Record (Filliable PDF)
• Information and Consent for Treatment (Fillable PDF)
• Therapist-Client Agreement (Fillable PDF)
• Information and Consent to Participate in Therapy as a Collateral Person to Treatment (Fillable PDF)
• Information and Consent to Psychological Services (Fillable PDF)
• Authorization for Psychological Evaluation (Fillable PDF)
• Informed consent regarding use of telehealth  (Fillable PDF)
• Clinical Center Release of Information  (Fillable PDF)
• Clinical Center Release of Information - Instructions (PDF)
• Safety Plan (Fillable PDF)
• Instructions for Clients to access Zoom (PDF)
• Zoom Video Instructions for Clients (MP4)
• Reduced Fee Application (Fillable PDF)