Melissa Chaffer, MA, LCPC The Arlington Center
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Forms

Download
Download
DOWNLOAD
DOWNLOAD
Download

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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  • Home
  • Forms
  • About
  • Contact
  • Locate
  • Insurance