Authorization to Release Information

IPD requires that an IPD Authorization to Release Information form be completed by the patient prior to our releasing, or requesting, medical records on the patient’s behalf.

Please select, print and complete this authorization form.

There are three very important items that must be done to complete the form.

  1. Please sign and date the form where it says “signature of client.”
  2. A witness MUST be present when the form is signed and that witness MUST sign the form and date it for it to be valid. Have the witness sign it where it says “signature of witness.”
  3. Write in the line after “for the purpose of:” the reason why medical records are being requested.

For your convenience, you can fax the signed authorization to IPD’s confidential medical records fax number:

Joliet: 815-725-7166
Morris: 815-941-0308
Ottawa: 815-941-0308
Romeoville: 630-226-9475
Chicago: 312-929-3022

**There is a standard processing fee of $30.00 for any medical records that are released**

What is qEEG?

A Quantitative EEG (qEEG) is a painless, diagnostic test that records the electrical activity of your brain. It has no side-effects and is useful for determining brain related conditions such as attention disorders, anxiety, depression, stroke, tumor, head injury, memory difficulties and seizures.

During your appointment, the technologist will measure your head and use a sticky paste to apply 21 sensors, called electrodes, to your scalp, an electrode to each ear lobe, and one electrode to your chest for recording your heartbeat.

Throughout the test, the room will be in partial darkness and you will sit quietly in a comfortable chair. At times you will rest with your eyes closed, and at other times, your eyes will be open. We will also record while you use a laptop to interact with some computer-generated sounds and shapes.

Next, you will be asked to do some deep breathing for about three minutes, and lastly, you will rest in the recliner with your eyes closed for about twenty minutes. During that time, we would like you to be comfortable and relaxed, and if possible, take a brief nap. When the testing is complete, the technologist will remove the electrodes and try to remove most of the paste.

At home, any remaining paste can be removed by shampooing with warm water. It will take about ten days to analyze your data and write a report, so please schedule your follow-up appointment to discuss your results after that time. This information will aid in development of appropriate interventions that are tailored to your needs. If you have any other questions, please feel free to call the office or ask your technologist before the test.

Thank you.

Insurance

    • Aetna
    • BC/BS
    • BHS
    • CAT/UHC
    • Chestnut (EAP)

    • Cigna
    • Compsych
    • Health Alliance
    • Humana
    • Magellan

    • Medicare
    • MHN
    • Multi Plan/PHCS
    • RailRoad Medicare
    • Tricare

    • UBH / UHC
    • Value Options
    • (Beacon)

FAQs

What Is Your Approach?

IPD provides services that are individualized for each and every client. Our clinicians are highly trained and focus on a thorough evaluation of the cause of your emotional pain. We examine problems in an individual’s relationships, job and life. We seek to understand the environment in which you grew up and how this may have effected how you view the world. We make every effort to understand the value system which you hold dear. We evaluate if you are on medications which could be making you feel bad, if you might have a medical disorder which effects how you feel or if you might have a brain chemistry problem causing you to distort the way you see and experience the world.

Once a thorough evaluation is completed, a treatment plan is designed and discussed with the individual and (with the patient’s permission), the family. We identify treatments which are scientifically proven to be effective in the condition or conditions which you have presented and then we “get to work.”

It is important to us that you OBTAIN RESULTS AND IMPROVE YOUR QUALITY OF LIFE! Our goal is to assist with alleviating emotional pain and suffering for individuals, families and communities. Our plan for treatment is to improve each individual’s quality of life. Within treatment, we use traditional and complementary approaches applied to the highest level of clinical and ethical standards.

How Soon Can I Get an Appointment?

This varies on the doctor you are seeing. Some doctors are scheduled more solidly than others, and emergencies can come up which can alter a doctor’s schedule. It is recommended that you schedule your appointments with as much notice as possible to get the date and time that is good for you.

How Do I Contact My Doctor or Clinician?

During the day, call 815-942-6323, Press 5 and leave a message for your clinician. Please convey the nature of the problem to help your clinician understand the level of urgency of your concern.

If there is an urgent issue after hours, you need to contact your doctor or clinician, please call our answering service at 888-549-3197 and ask your doctor or clinician to be paged.

If you have a clinical matter you wish to discuss with your clinician, we suggest that you call to make an appointment to see your clinician as soon as possible. You can ask the secretary, if there is not an immediate appointment available, if you could get in on an emergency visit with our Nurse Practitioner who can directly get input from your clinician as to how to proceed.

During office hours our doctors are always seeing patients, in most cases you will need to leave a message and the doctor will return your call as soon as possible. If it is an emergency our staff will alert the doctor right away. Keep in mind that doctors may charge for phone consultations, insurance does not cover this charge.

If there is an emergency, please call 911 or go to the nearest emergency room. The emergency room physician can contact our doctors through the answering service 888-549-3197.

How do I get refills for my prescription(s)?

You can call the office and request refills over the phone. Refill requests can take up to 48 hours to be completed.

Why does my statement show there was no payment from the insurance?

This is often because the insurance company has applied this amount to your deductible. Please refer to your insurance EOB or call your insurance company to be sure.

I am being charged for a telephone consult or a no show/late charge, has this been billed to my insurance?

No. Insurance companies almost never pay for such charges.

Are financing options available?

Med Loan Finance is one of the finest medical finance companies and is dedicated to finding the perfect fit for our customers’ needs. They work with people of all credit histories and backgrounds, and have an extensive base of lenders and providers make it possible to offer the best medical financing around. From their [website]:

Amounts from $500 to $100,000 / Lowest Interest Rates Available* / 6-21 Months Interest Free* / No Pre-Payment Penalty* * Depends on Applicants Credit and Lendor Financing for Behavioral Health Treatment is available!

Med Loans dedicated team of agents comes with years of experience, which means they know how to leverage lending companies to get the most competitive rates. Many of our customers enjoy options for no-money down, as well as interest free medical options for 12-21 months. Even those with average credit are often able to enjoy interest free options as well as no-money down, and those with poor credit are generally approved on an appropriate program that offers competitive rates.

Med Loan Finance wants to help people who care about their health, which is why they strive to provide the financial tools to help pay medical bills. To get started with one of their interest free loans, fill out our online application that takes just minutes to complete. Then you will be directed to our Loan Search Form that has different options for you to select from including the Interest Free periods and payments as low as 1% of your balance. Then within 1 business day we will notify you of options that we may have obtained for you.

To apply for a Med Loan today click: APPLY NOW