Hello and Welcome to Chapin & Russell Associates!
We are glad you have chosen us for your counseling needs.
In an effort to quickly connect you with a therapist, the intake form that follows in the link below collects all the necessary information for you to begin your counseling services. This allows us to efficiently gather all the information we need to match you with a counselor who can best meet your needs. It is a simple process and should take you about 10 minutes to complete.
A few things to keep in mind:
- If you’re filling this out for someone under 18, this form needs to be completed by a parent or legal guardian.
- If you are using insurance, please have your insurance card ready and carefully enter your insurance information paying close attention to the policy number and group number so that we can properly verify your benefits.
- If you have the ability to upload a copy of your driver’s license and insurance card you may do so by clicking the “ID Card” button to the right of the “PRIMARY CLIENT INFORMATION” title at the top of the intake page.
- To take advantage of our convenient payment method we encourage you to provide your credit card or debit card information. This will allow easy payment of fees and services that may accrue on a recurring basis. To do this please click the “Add Credit Card Details” button during the registration. This information is stored securely.
- Finally, please read and e-sign the attached forms that follow in the intake link.
Once the preregistration is complete and your intake has been submitted, we will contact you as quickly as possible to schedule your appointment. Upon receipt of your insurance information, (as applicable), we will verify your benefits and provide you with your projected out-of-pocket costs prior to your initial session. To be fully informed we recommend you also call your insurance plan and double-check your coverage for mental health services.
If you have any questions about the intake forms or need other assistance, please contact our support staff at (309) 396-6411 during our regular office hours, Monday through Thursday, 8am to 5pm and Friday, 8am to 4pm. We will be happy to assist you!
OPEN INTAKE FORM