Brightland Health

Psychiatry & Psychotherapy

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     312-796-7121

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    FORMS

    Documents Available for download

    Prior to your first visit to Brightland Health, you may download and complete the New Client Intake Form at your convenience. 

    Download at your convenience

    pdf document

    New Client Intake Form

    pdf document

    Notice of Privacy Practices

    pdf document

    Credit Card Authorization Form

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    HIPPA Authorization Form

    pdf document

    Telehealth Consent Form

    800 W. Diversey Pkwy. #200

    Chicago, IL 60614​

    312-796-7121

    Fax: 888-523-4767​

    info@brightlandhealth.com

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