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Park Ridge Psychological Services 36 Main Street, Ste. 106 Park Ridge, IL 60068Patient InformationInsured Information (if different from patient)Patients Name: Insured Name: Patients Birthdate: Insureds
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Step 1: Begin by reading the initial intake informed consent document carefully.
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Step 2: Fill out your personal information, such as name, address, phone number, and email address.
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Step 3: Provide information about your medical history, including any past illnesses, surgeries, or medications you have taken.
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Step 4: Answer any questions related to your current health status and disclose any allergies or medical conditions you may have.
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Step 5: Sign the document to indicate that you understand and agree to the terms stated in the initial intake informed consent document.
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Step 6: Return the filled-out document to the appropriate person or organization as instructed.
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Step 7: Keep a copy of the document for your records.

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The initial intake informed consent document is a form used to obtain a client's consent to participate in a particular process or service, ensuring they are fully informed about the implications and details involved.
Typically, healthcare providers, therapists, counselors, or any professionals offering services that involve client participation are required to file the initial intake informed consent document.
To fill out the initial intake informed consent document, assess each section carefully, provide necessary personal information, understand the terms stated, and provide a signature indicating consent.
The purpose of the initial intake informed consent document is to ensure that clients understand the nature of the services being provided, any risks involved, and their rights before agreeing to proceed.
The information that must be reported includes the client's personal details, the scope of services, potential risks, confidentiality policies, and the client's rights.
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