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:
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!