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New Patient Smiling Woman

New to
Lott Behavioral Health?

Let's get you started!

New Patient Number 1

Call Our Office

To schedule a new patient appointment, please call our office. We will ask some questions about why you are seeking care and confirm that we offer the correct services. We will also give you instructions on what forms need to be submitted in order to schedule your first visit.

Please call the office prior to completing the following forms.

New Patient Number 2

Complete Forms

After calling the office, please complete the Patient Information Form and the Office Policies Form. These can be submitted online or printed and mailed to the office. Please allow at least 15 minutes to complete the Patient Information Form. If you are the parent of a patient who is under 18 years old, the Consent for Release of Information Form is also needed.  

New Patient Number 3

Schedule Initial Appointment

After submitting the new patient forms, call our office to schedule your initial evaluation with one of our providers, who will review your history and work with you to create a personalized treatment plan.

New Patient Forms

Patient Information Form

Provide your contact and insurance information, as well as details on your medical history, current concerns and current medications.

Document Upload

Only to be used for uploading documents. For all other communication call 630-730-5506.  

Upload images/PDF’s of the following:

1. Front and back of insurance card

2. Front of driver’s license

3. Signed release of information (if applicable)

This can be done easily by opening this website on your phone.

Office Policies Form

Learn about our office policies and acknowledge receipt of our Privacy Practices.

Consent for Release of Information Form*

Print and complete this form to allow us to disclose your information to a loved one or another provider.  Upload a photo or PDF of the completed form using the upload button.  See sample here.

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*Needed for parents of patients under the age of 18 and other info exchange

**Note that submitted forms and documents are not checked on a timeline and are never checked outside of business hours. In case of an urgent situation please call 9-1-1.

Spravato Forms

These links should direct you to forms you may need if you are applying for esketamine (Spravato) treatment through our office.  Please complete these forms if directed by our office staff, and then submit them to us.  Forms may be submitted through the document upload feature below

Spravato REMS Form

Print form, complete on paper, then upload using "Upload" button below.

PHQ-9 Form

Complete form online then add total combined score.  All fields on the form must be completed for it to submit.

Document Upload

Only to be used for uploading documents. For all other communication call 630-730-5506.  

This can be done easily by opening this website on your phone.

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