Location 1751 South Naperville Road. Suite 207 Wheaton. IL 60189 Phone (630) 774 8316 | (630) 674 1138 Fax (630) 690-3353 Email info@theselfempowermentcenter.com
Demographic Information Form HIPAA Notice of privacy practices Consent to use or disclose information for treatment, payment, and health care operations (TPO) Authorization to Release Information Fee and cancellation policy Adult Mental Health Assessment Child and Adolescent Mental Health Assessment Marriage Interview Form Insurance Authorization Verification Form
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