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YOUR CART

Forms
The following paperwork requires your review and signature. We will go over the paperwork and your questions during the first session.
If you plan to send me the paperwork through email, please review my Email Confidentiality Policy before doing so.  Reach out with any questions at 847-502-5218.


EMAIL POLICY
Client information form
Service Agreement
PHI receipt form (HIPPA Acknowledgement)
Non-secure request
Credit card on File
HIPPA
Electronics Policy

Telehealth
Telehealth CONSENT
distance therapy video quality tips

Self-pay clients
OUT OF NETWORK
No Surprises Act
Insurance Opt out
GOOD FAITH

Additional Paperwork
Release of Information
Coaching Services
WALK AND TALK CONSENT
RESOURCES
Together, we will find a better way.

DrKo@ConnectPsychologicalServices.com
847-502-5218

Dr. Karen O'Keeffe  -  1580 S. Milwaukee Ave, Suite 407  -  Libertyville, Illinois  60048