Prior to your first visit, please download and fill out the Patient Registration Form. If you don't have access to a computer or printer, the form can be printed and filled out upon first visit.
| kjs_patient_registration_5...doc |
| 40_question_survey.jpg |
| vaccine_schedule.pdf |
| consultation_form_3.24.12.doc |
Kenneth J. Stanek, PhD, LCPC, BCPC, SC
Licensed Clinical Professional Counselor
Board Certified - American Psychotherapy Association
Fellow, American Psychotherapy Association(DAPA)
4415 W. Harrison, Suite 307, Hillside, IL 60162
708.439.1327 \ FAX: 708.924.1328
www.kenstanek.net
Licensed Clinical Professional Counselor
Board Certified - American Psychotherapy Association
Fellow, American Psychotherapy Association(DAPA)
4415 W. Harrison, Suite 307, Hillside, IL 60162
708.439.1327 \ FAX: 708.924.1328
www.kenstanek.net
Please feel free to fill out the information below and someone will be in contact with you within 24 hours.
