Request for Services & Fee Schedule

Intake Form

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If you're a new client, please complete the following forms and either email them to or bring them to your first therapy session.

Limits of Confidentiality/Cancellation Policy

Authorization to Disclose Information

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Tele-Mental Health Consent Form

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© 2017 by Wisnu Meier. Proudly created with

T: 309-472-0798

F: 309-643-1227

7501 N University St Suite 225

Peoria, IL  61614

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