1752 Capital St. Suite 100. Elgin. IL. 60124

(847) 695-3680

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Resources

Client Forms & Documentation

Please download and complete the necessary forms prior to your scheduled appointment.

Online Client Survey

Help us provide better services by completing this online survey please.

Eligibility/Engagement

It helps us determine your, or your child's, eligibility for services

Behavioral Management

Describes how we handle behavior problems in case they occur at one of our offices.

Cancellation Policy

Explains how we handle appointment cancellations.

Client Fee Agreement

Describes regular fees for different services.

Fee Schedule

Describes costs for services.

Client Fees Policy

Helps determine a client’s ability to pay for therapeutic services offered by the agency.

Sliding Fee Scale Application

It helps us determine the amount you would pay for services depending on your income

Client Rights

It explains you rights and responsibilities as a Family Service Association Client

Forms To Sign

Group of forms you must sign before receiving services

HIPAA

Explains how your protected health information is handled. It also explains your rights as a Family Service Association client

Family Support Program (FSP) Application

FSP application packet

Client Survey

Help us provide better services by completing this paper survey please.