CLAY Therapeutic Services
CLAY Therapeutic Services

Patient Forms

New patients will need to fill out several forms before therapy can begin. To make the process as smooth and efficient as possible, we provide the most important documents as downloads right here on our website.

 

Find out which forms you need to submit, select the appropriate download link and return the completed documents to our practice either in person, by fax or as a scanned PDF file via e-mail. Naturally, all forms are also available at the practice; however, filling them out in advance saves time.

If you are unsure which forms to fill out, don't hesitate to contact us.

Credit Card Billing Authorization Form
new credit card form.docx
Microsoft Word document [12.9 KB]
AUTHORIZATION TO USE OR DISCLOSE PROTECT[...]
Microsoft Word document [14.6 KB]
Patient Registration Form
Patient Registration Sheet HIPPA 2.doc
Microsoft Word document [54.0 KB]

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.

Where to Find Us

CLAY Therapeutic Services

2356 Hassell Rd Ste L

Hoffman Estates, IL 60169 

 

Satellite office

10 E 22nd Street Ste 217

Lombard IL 60148

 

Phone: 815-325-1411

Email: claytherapeuticservices@gmail.com

 

Or use our contact form.

Patient Forms

New patient? Save time and reduce the amount of paperwork you have to fill out at your first visit. We provide several patient forms as PDF downloads on our site.

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