Clocktower Therapy Center New Patient Information
We are pleased that you have chosen us. We provide this website and information so that you may familiarize yourself with our office policies and procedures. Most of your questions should be answered here. You are also encouraged to pick up a copy of our financial and prescription refill policies at your first appointment. If you are uncertain about any of our office procedures, please call us at 217-793-0680.
Clocktower Therapy Center is an association of independently practicing professionals who share office space and certain administration functions. Each provider is completely independent in providing you with clinical services and is solely responsible for those services. Each provider's medical records are separately maintained and no other provider may have access to them without your written permission. More detailed information regarding confidentiality and your privacy can be found in the new patient registration packet.
New Patient Procedures
As a new patient, you will be greeted at the reception desk and will be asked to complete a comprehensive registration packet. Please allow 15 to 20 minutes ahead of your scheduled appointment time to complete the paperwork.
In order to complete the registration packet, you will need to provide:
- The name, address, date of birth and Social Security Number of the person listed on the insurance card
- Your insurance card, and your insurance company address
- Insurance referral, authorization, or certification paperwork, if applicable
- A photo I.D.
- A list of all prescription or over-the counter medications you are taking
In addition, you may be asked to bring past medical records, or lab reports. Please make sure to bring these with you, if requested, so your provider can fully evaluate your medical history and condition.
Patient Intake Forms
Download, print, complete and bring to your appointment:
Adult forms... (PDF 8 mb)
Child / Dependant forms... (PDF 6.7 mb)
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