Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.

All comprehensive Assessments will be conducted in-person and on a walk-in basis. Walk-in days are Tuesday and Wednesday in Round Lake, and Thursday and Friday in Waukegan. Arrive early to sign in (sites open at 8am) as only 3 comprehensive Assessment appointments will be conducted each day. If you are unable to attend during walk-in hours, please call (847)546-6450 to schedule an appointment.

All DUI Assessments will be conducted in-person and on a walk-in basis. DUI walk-in days are Thursday and Friday in Round Lake, and Tuesday and Wednesday in Waukegan. Arrive early to sign in (site opens at 8am). Individuals will be seen as soon as possible, but may not be seen until the afternoon depending on how early they sign in. If you are unable to attend during walk-in hours, please call (847)546-6450 to schedule an appointment.

English

Evaluation - DUI (English)

Evaluation - Gambling (English)

Evaluation - Non-DUI (English)

Family Advocacy (English)

Intake - Gambling (English)

Intake - GOALS and Anger Management (English)

Intake - Minimal Risk (English)

Intake - Moderate Risk (English)

Intake - Retail Theft (English)

Intake - Treatment (Significant, High Risk, and Intensive Outpatient)

Secretary of State (English)

Telehealth Services Agreement (English)

Universal Precautions and Information-Influenza, HIV, and TB (English)

Spanish - Español

Evaluation - DUI (Spanish) - Evaluación para la Conducción Bajo la Influencia de Alcohol y/o Drogas

Evaluation - Non-DUI (Spanish) - Evaluación para Otros Servicios que No Son de la Conducción Bajo la Influencia de Alcohol y/o Drogas - Evaluación para Otros Servicios que No Son de la Conducción Bajo la Influencia de Alcohol y/o Drogas

Intake - High Risk (Spanish) - Admisión de Alto Riesgo

Intake - Minimal Risk (Spanish) - Admisión de Bajo Riesgo

Intake - Moderate Risk (Spanish) - Admisión de Riesgo Moderado

Intake - Significant Risk (Spanish) - Admisión de Riesgo Significativo

Telehealth Services Agreement (Spanish) - Acuerdo de Consejería por Teléfono y/o Video

Universal Precautions and Information-Influenza, HIV, and TB (Spanish) - Precauciones Universales e Información de Gripa, VIH, y TB

 

Contact Today

Please complete these steps and bring documentation to your first DUI appointment.

Instrucciones para la Documentación Necesaria para una Evaluación para la Conducción Bajo la Influencia de Alcohol y/o Drogas (Español).

DUI Evaluation
Required Documentation Instructions

La Documentación Necesaria para Recibir Una Evaluación para la Conducción Bajo la Influencia de Alcohol y/o Drogas (DUI)

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