Ann James Counseling, LLC | Rockford, IL
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      • Depression
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      • Self Esteem
      • Life Transitions
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      • Grief Counseling
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Printable Forms

New Client Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.
Registration
File Size: 187 kb
File Type: pdf
Download File

Hippa Acknowledgement
File Size: 172 kb
File Type: pdf
Download File

HIPPA Information
File Size: 151 kb
File Type: pdf
Download File

Release Of Information
File Size: 164 kb
File Type: pdf
Download File

Child Adolescent Form
File Size: 399 kb
File Type: pdf
Download File

Adult Information Form
File Size: 323 kb
File Type: pdf
Download File

Consent for Psychotherapy
File Size: 77 kb
File Type: pdf
Download File

Financial Policy
File Size: 90 kb
File Type: pdf
Download File

Telehealth Therapy

Instructutions For Telehealth
File Size: 141 kb
File Type: pdf
Download File

Telehealth Consent
File Size: 157 kb
File Type: pdf
Download File

Current Client Forms

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
Release Of Information
File Size: 237 kb
File Type: pdf
Download File

Note: To download Adobe Acrobat Reader for free, click here.
Contact Us
 Ann James Counseling, LLC 
​
1639 N. Alpine Rd.
Suite 204
Rockford, IL 61107

P: (779) 423-0275
F: (815) 516-5952

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Contact Us

Ann James Counseling, LLC 
1639 N. Alpine Rd.
Suite 204
Rockford, IL 61107

P: (779) 423-0275
F: (815) 516-5952

Location

Website by TherapyPrime
  • Home
  • About
    • Meet Our Team
    • Rates & Insurance
    • Tour Our Office
    • Privacy Policy
    • Disclaimer
  • Services
    • Therapy Services
    • Clinical Supervision
  • Therapy
    • Children & Adolescents >
      • Mood Disorders
      • Anxiety Disorders
      • Conduct Disorders
      • Deveolpmental Disorders
      • ADHD
      • Emotional Disturbance
      • Depression
      • Separation Anxiety Disorder
    • Mental Health >
      • Mood Disorders
      • Depression
      • Bipolar Disorders
      • Anxiety Disorders
      • Obsessive-Compulsive (OCD)
      • Adjustment Disorders
    • Relationship Issues >
      • Family Counseling
      • Family Conflict
      • Parenting Support
    • Personal Growth >
      • Self Esteem
      • Life Transitions
      • Social Skills
      • Stress Management
    • Coping Skills >
      • Grief Counseling
      • Anger Management
  • Resources
    • Printable Forms
    • Client Portal
    • What To Expect
    • Helpful Links
    • Common Questions
    • Helpful Books
  • Blog
  • Contact
    • Book Appointment
    • Pay My Bill
    • Connect With Us