register for services

Prior to entering into a counseling relationship with Personal Balance Counseling (PBC), it is important that we establish the foundation for a beneficial therapeutic relationship.  Establishing this foundation starts with the completion of a PBC registration packet. 

The registration packet includes the collection of personal and mental health information that is used as input into the Intake Assessment process as well as other administrative items such as PBC’s office policies and billing procedures, insurance information and declarations and notice of privacy practices.

Call Personal Balance Counseling at (708) 949-8688 to receive the registration forms via EMAIL or complete the registration forms ONLINE or CLICK on the form name to download to your personal computer to print and complete.  Return all completed registration forms to PBC prior to the start of your treatment.

Demographics, Consent to Treatment, Health Care Information         ONLINE

Office Policies and Billing Information                                                        ONLINE

Insurance Declaration, CC Authorization, Insurance Information         ONLINE

Electronic and Social Media Consent                                                          ONLINE

Notice of Privacy Practices                                                                           ONLINE