Eric Tivers, LCSW, MSSW 224.636.3742 etivers@aol.com
Agreement for services Contract.pdf
Permission to Provide Therapy.pdf (Required for all clients under 18 years old)
Release of information.pdf (print one for each person you are authorizing Eric to communicate with, including teachers, grandparents, doctors, other therapists, etc)
electronic communications consent.pdf
HIPAA Privacy Notice.pdf (Print or save for your records)
Downloadable Forms
Please fax or email completed forms to first visit.
Fax: 847.886.7251 email: etivers@aol.com