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    Envision Therapy, PLLC
    900 North Shore Drive, Ste 200
    Lake Bluff, IL 60044
    donna@envisiontherapy.com | 847-238-2458

  • Donna Oldenburg

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    Client Forms

    If you are new to the practice, please be sure to complete the following forms, and bring them with you to your first session. If you have any questions regarding the forms, please call or email us.

    Client Intake Form

    HIPPA Privacy Policy Form

    Client Informed Consent Form

    To ensure the best possible care, Envision Therapy may wish to collaborate with your other health care providers. Please complete the following form if you wish to grant us access to your providers, or any medical records.

    Authorization for Release of Information

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    Envision Therapy, PLLC
    900 North Shore Drive, Ste 200 Lake Bluff, IL 60044

    847-238-2458 donna@envisiontherapy.com

    Contact Today

    By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

    Envision Therapy, PLLC
    donna@envisiontherapy.com | 847-238-2458

    A Website by Brighter Vision | Privacy Policy

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