Contact US (847) 796-6400 - contactus@360wc.com

Patient Forms


Please review and electronically sign the New Patient Intake Form:

New Patient Intake Form


Please review and electronically sign the Consent for Release Authorization Form:

Consent for Release Authorization Form


Please review and electronically sign the Authorization for Automatic Credit Card Payment Form:

Authorization for Automatic Credit Card Payment Form


Please review and electronically sign the Tele-MentalHealth consent form:

Tele-MentalHealth Consent Form


Please download and complete the Intake/Child Developmental Questionnaire:

Intake/Child Developmental Questionnaire


Please download and complete the Patient Health Questionnaire:

Patient Health Questionnaire (PHQ-9)