(309) 692-7755 Fax: (309) 692-2262

John R Day & Associates, Ltd
Christian Psychological Associates

John R Day & Associates, Ltd Christian Psychological AssociatesJohn R Day & Associates, Ltd Christian Psychological AssociatesJohn R Day & Associates, Ltd Christian Psychological Associates

John R Day & Associates, Ltd
Christian Psychological Associates

John R Day & Associates, Ltd Christian Psychological AssociatesJohn R Day & Associates, Ltd Christian Psychological AssociatesJohn R Day & Associates, Ltd Christian Psychological Associates
  • Home
  • About Us
    • Who We Are
    • Our Therapists
    • Our Staff
    • Blog
    • News and Updates
  • Services
    • Our Services
    • Forms
    • Policies
    • Insurance Information
    • Telehealth
    • Patient Ally
    • Resources
  • Locations
    • Locations and Maps
  • More
    • Home
    • About Us
      • Who We Are
      • Our Therapists
      • Our Staff
      • Blog
      • News and Updates
    • Services
      • Our Services
      • Forms
      • Policies
      • Insurance Information
      • Telehealth
      • Patient Ally
      • Resources
    • Locations
      • Locations and Maps

(309) 692-7755 Fax: (309) 692-2262


  • Home
  • About Us
    • Who We Are
    • Our Therapists
    • Our Staff
    • Blog
    • News and Updates
  • Services
    • Our Services
    • Forms
    • Policies
    • Insurance Information
    • Telehealth
    • Patient Ally
    • Resources
  • Locations
    • Locations and Maps

Welcome!

Making a decision to seek counseling is not easy. If you would like to initiate therapy or psychological testing, please select the link below. Make sure you fill out all the information requested. Incomplete forms will delay the process. Thank you!

New Patient Intake

Other Documents

These additional forms are used as needed. Please read more about our policies on our Policies page. 

RELEASE OF INFORMATION (pdf)Download
AUTO PAY AUTHORIZATION (pdf)Download
UPDATE PATIENT INFORMATION (pdf)Download
SLIDING FEE DISCOUNT APPLICATION (pdf)Download
FINANCIAL POLICY (pdf)Download
COMMUNICATION POLICY (pdf)Download

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114 N Main St. (black awning)

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