Patient Forms & Privacy | RenewMind Psychiatry & Wellness

Respectful, Confidential Care

We are committed to protecting your health information and providing care that respects your dignity, preferences, and individual circumstances. You are encouraged to ask questions, participate in decisions, and share concerns about your treatment.

Please do not send sensitive medical information through ordinary email, public contact forms, or social media. Secure intake, messaging, and records requests will be handled through approved systems.

Patient Rights & Responsibilities

Patients can expect respectful communication, information about recommended treatment, and appropriate privacy protections.

We ask patients and families to provide accurate information, follow agreed scheduling procedures, and communicate medication or safety concerns promptly. Consent, adolescent privacy, and caregiver participation are discussed in accordance with applicable law and clinical needs.

Forms, Consents & Practice Notices

Secure Patient Forms — Coming Soon

Before the practice begins seeing patients, approved documents will be made accessible through the verified secure patient portal:

Notice of Privacy Practices
Patient registration and intake forms
Consent for treatment
Telehealth consent
Release of information
Financial policy
Cancellation/no-show policy: 24 hours’ advance notice; $50 late cancellation fee; $100 no-show fee, subject to applicable insurance and payer restrictions.

Please do not email completed clinical documents. Secure access links will be activated after the practice supplies and approves the portal URL and final documents.

Patient Center

Need Administrative Help?

Call (815) 881-1039 for general questions about appointments, paperwork, or office information.

Do not send private medical details through ordinary email or public contact forms.