New Client Forms

New Patient Paperwork                                                    

You will need Adobe Reader or another pdf reader to open the file. Note: To download Adobe Acrobat Reader for freeclick here.

What to Bring to Your Appointment If You are a New Patient at JCCR

  • Picture ID
  • Insurance card
  • List of prescription medications and dosages
  • Current contact information
  • Emergency contact information
  • Any and all relevant Psychiatric records such as office/hospital notes 

If you are scheduled for an initial evaluation, please click on the link below, print, fill it out to the best of your ability, and bring or mail the completed form for your first appointment.

JCCR RELEASE OF INFORMATION FORM

TELEPSYCHIATRY CONSENT FORM

 Patient Self Rated Form Paperwork

"Please note, these self-rated scales are not a substitute for a psychological or psychiatric evaluation and are not intended to diagnose or treat.  They are designed to be used in conjunction with your treatment provider.  If you do decide to complete any of the below scales, please review the results with your licensed mental treatment provider.  If at any point you feel suicidal, homicidal, are hallucinating or feel that you may be a threat to yourself or others, please call 911 or visit your nearest Hospital  Emergency Room."  Please be aware that there will be no one to take your call if it is after hours or a non-business day including Sat., Sun and holidays.  Please allow one business day for a response to any message left for the office.

 

TEACHER VANDERBILT ADHD DIAGNOSTIC  RATING SCALE

PARENT VANDERBILT ADHD DIAGNOSTIC RATING SCALE

ADULT ADHD SELF-REPORT SCALE SYMPTOM CHECKLIST

SHEEHAN DISABILITY SCALE

BECK DEPRESSION INVENTORY

BECK ANXIETY INVENTORY

BINGE EATING DISORDER SCREENER 7

PHQ-9

GAD-7

 

Contact:

Joliet Center for Clinical Research 
210 N Hammes Ave 
Suite 205 
Joliet, IL 60435  

Appointments: 815-729-7790 ext 1

Billing: 815-729-7790 ext 3

Facsimile: 815-725-8144            

Email: [email protected]

Contact Me

Location

Availability

Primary

Monday:

Please contact us for availability

Tuesday:

Please contact us for availability

Wednesday:

Please contact us for availability

Thursday:

Please contact us for availability

Friday:

Please contact us for availability

Saturday:

Please contact us for availability

Sunday:

Please contact us for availability