Statement of Financial Responsibility

HIPPA Consent

Application Form

Preferred Payment Arrangement 

Informed Consent for Video Sessions

Contact:

Location
Chaffer Counseling, LLC
Melissa Chaffer, LCPC
8600 U.S. Rt. 14, Suite 110
Crystal Lake, IL, 60012

Phone
779.220.0340
​
Email
Counseling@Chaffer.net
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