Mental Health & Counseling Services


Member of the American Psychological Association

3380 Lacrosse Lane

Suite 106

Naperville, IL 60564


64 Orland Square Drive

Suite 112

Orland Park, IL 60462


Tel:  630.206.4060

Fax: 855.871.8351

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© 2019 by Konick & Associates.


Forms & First Visit

We want your initial visit to go as smoothly and stress-free as possible. Below you will find several forms and questionnaires that can be completed prior to your initial appointment. Having these ready when you arrive will help ensure your first visit is a little easier.



Please complete these forms to the best of your ability.


In addition to the forms above, the following items will be helpful to have if available at your initial appointment:


  • A copy of any previous hospitalization records

  • A copy of any previous neuropsychological or psychological evaluations

  • A copy of early intervention assessments (speech, occupational therapy, etc.)

  • A copy of IEP or 504 documents


This information will be important to fully understand your past and current functioning, and will help to guide your ongoing assessment and treatment.  Please contact our office with any questions or concerns.


Informational guides are available through the following links to provide you with an overview of our Client Portal and our Telehealth platform:




Family Behavioral Health, Counseling  and
Psychological Assessment