Patient Forms

New patients will need to fill out several forms before therapy can begin. To make the process as smooth and efficient as possible, I have provided the most important documents as downloads right here on my website.

 

Find out which forms you need to submit, select the appropriate download link and return the completed documents to my practice either in person, by fax or via e-mail. Naturally, all forms are also available at my office; however, filling them out in advance saves time.

If you are unsure which forms to fill out, don't hesitate to contact me.

Consent to Treatment Form
This document details your consent to treatment as a patient of Dr. Michael Jilke.
Consent to Treatment Form.pdf
Adobe Acrobat document [88.7 KB]
HIPPA Notice of Privacy Practices
This document details your privacy and limits of confidentiality as a patient of Dr. MIchael Jilke.
HIPAA Privacy Notice.pdf
Adobe Acrobat document [148.5 KB]
Couples Consent Form
This document details your consent to couples counseling with Dr. MIchael Jilke.
Couples Consent Form.pdf
Adobe Acrobat document [24.5 KB]

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.