Disclosing Information

If you would like us to coordinate care with another provider (for example, your primary care physician, neuropsychologist, SLP, OT, PT, etc.), complete this form to authorize release of information:

Credit Card Authorization

If you would like to make a payment using a credit card, please download the form below and fax to Lindsay at 708-995-5684. Please note, we destroy, and do not keep any payment information on file. If you would like to make recurring credit card payments you will need to complete a new authorization for each transaction. Thank you!