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Sue H. Bae, Ph.D. & Associates

Forms

This form outlines our policies and practices for teletherapy.  Please read it thoroughly prior to your first teletherapy appointment.

This form outlines our policies and practices. Please read it thoroughly prior to your first appointment.

This form also gathers basic contact information, including insurance. This form is for and adolescent clients.

This form gathers basic contact information, including insurance. This form is for adult clients.

This is a consent form that allows for communication to occur via email, text or any other manner.

This form outlines Illinois' HIPAA Privacy Rights and Practices. This packet is for clients to read through and keep for reference. At the end of the packet is a form to sign acknowledging receipt of this information.

This form is for any payment that must be collected after the insurance is billed, or for any co-pays.

These two forms are for collecting payment information for psychological testing services only. If you are a therapy client, you do not need to complete these forms.