Behavioral Health Education Specalists
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Contact BHES
Our Location:

14953 S Van Dyke Road
Plainfield, Illinois  60544

(815) 609-1544


Behavioral Health and Education Specialists

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Behavioral Health and Education Specialists Forms

Feel free to review and/or to complete the BHES forms below. Doing so will educate you more about BHES and it will allow your first visit to go more smoothly. You can view/print each form by clicking the form name below. Feel free to call us with any questions. 

Behavioral Health Forms

Plainfield Patient Intake Forms:

BHES Acknowledgment Of Receipt Of Notice Of Privacy Practices 

BHES Behavioral Health Financial Policy 

BHES Consent For Treatment

BHES Informed Consent For Prescribed Medications
(For Psychiatric Appointments Only)

BHES Medical History Questionnaire
(For Psychiatric Appointments Only)

BHES Notice of Privacy Practices

BHES New Patient Registration Form

BHES Pharmacy Selection Form

BHES Psychiatric Follow-Up Form
(For Psychiatric Appointments Only)

Other Forms:

BHES Consent for Psychological Testing

BHES Bariatric Consent For Psychological Evaluation

BHES Bariatric Pre-Operative Psychological Examination Information Sheet

BHES Patient Discharge Information Sheet

BHES Psychiatric Follow-Up Form

Education Forms

Intake Forms:

BHES Education Financial Policy

BHES Initial Consultation

Private Health Information Release Form

Authorization For Release Of Private Health Information

Call BHES Today (815) 609-1544