977 Lakeview Parkway, Suite 102, Vernon Hills, IL 60061 ... (847) 680-0755










Psychological Assessment
Co-Parenting Consultation
Parent Coordination
Collaborative Divorce
Professional Training, Supervision & Consultation
Community Education
Forms & Practice Information
Contact Us
About Hawthorn



Forms & Practice Information

On this page you will find the forms necessary for the service you are requesting from Hawthorn Counseling Group. The standard HCG fee schedule is included in each set of forms shown below.

Submission of a completed set of forms is requested before starting to receive services. Please print the appropriate set of forms, review, sign, scan and return via email to:


If the service you are receiving is covered by your health insurance plan and you wish Hawthorn Counseling Group to submit health insurance claims for services please also provide a copy of your health insurance card and include this with the materials. Of course, if you have any questions about any of these materials feel free to contact Dr. Jochem.

Fee Schedule

Fee Schedule


Psychotherapy Services Patient Registration Forms

Evaluation Services Patient Registration Forms

Co-Parenting Consultation Client Registration Forms

Parent Coordination Client Registration Forms

Mediation Client Registration Forms

Collaborative Divorce Client Registration Forms

Release of Information Form

Statement on Telehealth & Use of Email

Telehealth statement