Planning ahead

Please take a moment to download (PDF Format) and complete the following forms in advance of your visit, and bring them along to your scheduled appointment.

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Your feedback makes a difference

A moment of your time in responding to our satisfaction survey, helps us improve our service for your future visits and those of others in our practice. Your opinions are welcome and appreciated, and can make a difference, so please take a moment to respond.

Therapy Evaluation Questionnaire

Which psychologist did you work with?

In general, did you make good progress in therapy?
Definite YesYesUnsureNoDefinite No

If you had any concerns about your therapy or dissatisfaction with your psychologist, did you feel your psychologist was open to discussing them with you?
Definite YesYesUnsureNoDefinite No

Do you feel you were treated with respect, courtesy and kindness?
Definite YesYesUnsureNoDefinite No

If you had friends/relatives that you thought would benefit from therapy,
would you refer them to me?
Definite YesYesUnsureNoDefinite No

Have your problems changed for the better or worse as a result of your therapy?
Much WorseWorseNo ChangeBetterMuch Better

Please indicate things in therapy that did not work for you.

Please indicate any concerns you have that were not resolved in therapy.

Please check all those items below that apply to you:
I am in therapy with someone else.I would want to see you again if the need arose.My needs were/are met for the time being.My needs were not met.I would seek a different psychologist if the need arose.

Here are some items I would add to this questionnaire for future use:

If interested in receiving a Newsletter on various topics of psychological interest, please provide an address:
Home address:

Thank you for responding to this questionnaire. Your responses will help us provide a better service to our community.

Optional Information





Social Media Policy

This document outlines our office policies related to use of Social Media. Please read it to understand how we conduct ourselves on the Internet as mental health professionals and how you can expect us to respond to various interactions that may occur between us on the Internet.

Blog, Twitter, Facebook

We publish a blog on our website, we post psychology news on Twitter, and we keep a Facebook page for our professional practice to allow people to share the blog posts and practice updates with other Facebook users. You are welcome to view our Facebook Page and read or share articles posted there.  However, we have no expectation that you, as a client, will want to follow our blog, Facebook or Twitter stream. You are welcome to use your own discretion in choosing whether to follow us. Note that we do not follow you back. We only follow other health professionals on Twitter and we do not follow current or former clients on blogs or Twitter. It is NOT a regular part of our practice to search for clients on Google or Facebook or other search engines. Our reasoning is that we believe casual viewing your online activities without your consent and without our explicit arrangement towards a specific purpose could potentially have a negative influence on our working relationship. If there are things from your online life that you wish to share with your therapist, please bring them into the sessions where you and your therapist can view and explore them together during the therapy hour.

We hope that you will bring your feelings and reactions to our work directly into the therapy process. This can be an important part of therapy, even if you decide we are not a good fit. None of this is meant to keep you from sharing that you are in therapy with us wherever and with whomever you like. Confidentiality means that we cannot tell people that you are our client.


We do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc.). We believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of the therapeutic relationship. If you have questions about this, please bring them up when you meet with your therapist.

Texting and Email

Please do not use mobile phone text messaging or messaging on Social Networking sites such as Twitter, Facebook, or LinkedIn to contact us. These sites are not secure and we do not read these messages in a timely fashion. Do not use Wall postings, @replies, or other means of engaging with us in public online if we have an already established client/therapist relationship. Engaging with us this way could compromise your confidentiality. It may also create the possibility that these exchanges become a part of your legal medical record and will need to be documented and archived in your chart.

We prefer using email only to arrange or modify appointments. Please do not email your therapist content related to your therapy sessions, as email is not completely secure or confidential. If you choose to communicate with your therapist by email, be aware that all emails are retained in the logs of your and my Internet service providers. While it is unlikely that someone will be looking at these logs, they are, in theory, available to be read by the system administrator(s) of the Internet service provider. You should also know that any emails we receive from you and any responses that we send to you become a part of your legal record.

Contacting your Therapist

If you need to contact your therapist between sessions for a clinical issue, the best way to do so is by phone at (630) 377-3535. Direct email at or the direct line to the business office at (630) 530-5007 is best for quick, administrative issues such as changing appointment times or billing questions.


Thank you for taking the time to review our Social Media Policy. If you have questions or concerns about any of these policies and procedures or regarding our potential interactions on the Internet, do bring them to the attention of your therapist so that we can discuss them. As new technology develops and the Internet changes, there may be times when we need to update this policy. If we do so, we will update any policy changes on our website and have the information available in our office.



St Charles | 405 Illinois Avenue, Ste. 2C

Oak Brook | 1200 Harger Road, Ste. 220

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