Forms

To make the intake process as efficient as possible, the following forms are available online for you to print out and complete prior to your first appointment. Please note, this packet is not a crisis line. If you are in need of emergency assistance or experiencing a mental health crisis, please call 911, the Suicide Prevention Lifeline at (800) 273-8255, or the DuPage County Crisis Line at (630) 627-1700.

 

If you have any questions, please call us at (630) 693-7934.

Counseling Intake Form

Telehealth Intake Form

Notice of Privacy & HIPPA Agreement

Addison Police Department
3 Friendship Plaza, Addison, IL 60101
Office Hours: 
Monday - Friday: 9:00 AM - 4:00 PM

© 2020 Northeast DuPage Family and Youth Services  |  All Rights Reserved

(630) 693-7934
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