Affiliated Counseling and Referral Services

 

“ ABSOLUTELY no headaches. NO forms to fill out.   We bill your insurance directly.  Just make your small co-payment and you'll NEVER receive a bill from us-Ever!  Guaranteed!"  Since 1976.

 

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                Affiliated COUNSELING AND REFERRAL SERVICES (ACRS)

 

...serving Cary, Crystal Lake, Barrington, Fox River Grove, Schaumburg, Palatine, Woodstock, Lake in the Hills and McHenry, IL... 

 

 

                                               Dr. Michael Shery, Clinical Psychology

                                           2615 Three Oaks Rd. Ste 2A; Cary, IL 60013

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   Doctoral degree: University of Southern California

 

 

 

        Referrals accepted from Alexian Brothers, Good Shepherd, Centegra, Loyola, Northwestern University, University of Chicago and the Mayo Clinic hospitals and physicians.



 

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Counseling, Therapy and

Expert Evaluations for: 

 

- ADHD - Alcohol -Substance Abuse -Anger - Fitness for Duty - Disability -Adoption 

 

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www.carypsychology.com  847 275 8236 (24 Hrs);  drmike@carypsychology.com

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How to Become a New Client

 

 

The Easiest Method ... Just go to our appointment book now... and schedule your appointment>

 

 

Make appointment for Cary Office: Therapy and Counseling

 

 

You can fill-out your client information form there and make your appointment at the same time! 

 

 

Map to Cary Office 

 

 

It couldn't be easier!

 

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Or, just follow these 3 simple steps: 

 

1. Please fill-out the form below. Copy and paste it into an email

 

2. When finished, email it to me at: drmike@carypsychology.com.

 

3. Then call me (Dr Shery) at 1-847-275-8236 and I'll schedule an appointment for you on the spot. I'm looking forward to working with you.

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  Intake Form

Thanks for joining us.
 We value you as a client and are committed to helping you achieve your goals.

Issues: Please underline any of the following that apply: anxiety; depression; family/marriage/relationship problems; child-adolescent behavior; substance abuse_______ ; work problems; family/marriage; kids; smoking; weight loss; anger management; stress reduction; chronic illness; auto-work accident/injury; pain; other_____________________

I would benefit from: (please underline) telephone counseling; in-office counseling-psychotherapy; family counseling; marriage counseling; relaxation training; hypnosis to___________________;
pain management; adjustment to injury or illness; disability assessment/counseling; substance abuse treatment; relationship counseling; anger management; depression management; anxiety management; ADD evaluation; personality testing; stress reduction; other_____________

Patient Name_________________________________ Please underline: Marital

Status: Single Married Other; Employment: Employed Full Time Student Part-Time

Student; Pt. Email Address_____________________________; May we send

updates and information there? Y N Pt. Birthday:_______________; SS#________________________Address_______________________________

Pt relationship to insured:
 self spouse child other_______; Phone Numbers:____________________________________

Is there a phone # on your card listed specifically for mental health services?
If so, please include it:______________________________

If your condition has been caused
by a work injury or auto accident,
 please include the adjuster’s contact info here:
_________________________________________________________________

Insured’s SS #_____________________Insured’s Name____________________
Insured’s Address_____________________________________
Insured’s Phone#______________________________________
Insured’s Policy-Group-FECA#______________________
Insured’s Birthday______________
Employer-School Name____________________________________________
Insurance Plan Name__________________________
Insurance Benefits Verification Phone Number_______________________________

Is There Another Health Benefit Plan? Yes___________________________No___

Other Insured’s Name____________________________
Other Insured’s Policy or Group #__________________________
Other Insured’s Birthday:____________________
Employer/School Name________________________
Insurance Plan_______________________________
Insurance Verification Number_____________________
Address to Send Claims___________________________________________________

I acknowledge that my co-pay is payable at each visit with you billing my insurance company for the balance. If I cancel an appointment in less than 24 hrs in advance,
 I agree to pay ½ of the regular fee to compensate for my therapist and the office space not being available to others.
I recognize that I will be afforded absolute confidentiality within the parameters prescribed by law.

I also authorize you to release any information necessary to process my insurance claims and I request that the resulting benefits be assigned directly to, you, Dr. Michael E Shery as payment for the services rendered.

Signature:______________________________Date:_______________

Please email this form by clicking here now:  drmike@carypsychology.com

 

 

 

______________________________________________________________
For office use only:

Verify: Deductible__________Satisfied? Y N; Co-Pay__________Session Limits______________

Claims Address________________________________________________

90801-90806 Pre-Auth Required? Phone #:________________________Y N O; #__ of______;

#__of______; Case #_______________; Auth #________________

Good ‘til_______________96100 Auth Required? Phone #:_____________Y N O; #__ of______;

Y; Deductible______________Co-Pay____________

Tests: 16-PF
 A16+ 30; ABEL Screen (sx int) AAdol+ 180; CPI A 13+ 30; Dementia Rating Scale A65-81 60; Hare Psychopathy Checklist-R (PCL-R) A18+ 150; MAPI (pers inv) A13-18 60; MACI A13-19 60; Millon Beh Hlth (med coping) A18+ 45; MMPI-2 A18+ 60; MMPI-A A14-18 60; NEO Personality-R A3-12 120; Omni Person Inv A18-76 60; Omni 4 Personality Disorder Inv A18-76 60; PAI A18+ 60; Personality Research Form A11+ 60; Psychiatric Diagnostic Interview, revised (PDI-R) A18+ 45; Rotter Incomplete Sentence Test Achild+ 60; Structured Interview of Reported Sxs (malingering) A18+ 45; Trauma Sx Inv A18+ 30; Validity Indicator Profile (malingering) A18-69 60; Wechsler Ab Scale of Intelligence (IQ) 60

Verify: Blank/Completed Forms; Stamps; Clarifiers: Envelopes

Please email this form by clicking:  drmike@carypsychology.com 



 

 

 

 

 Next, Make your Appointment:

 

 

NEXT STEP:  Call Dr. Shery at 1-847-275-8236 and he'll schedule an appointment for you on the spot.

 

 

Map to Cary Office

 

 

Or... the easiest way is to just go to our appointment book now... and schedule your own appointment>

 

Make appointment for Cary Office: Therapy and Counseling

 

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To read about individual or marriage counseling>Marriage Counseling and Individual Psychotherapy

 

To read about telephone counseling>Telephone Counseling

 

 

>New Patient Registration

 

>How to Find the Right Counselor-the FIRST Time

 

>Northern Illinois: Drug-Alcohol Treatment Locator

 

> " Provider Search:" Find a Counselor Covered by your Insurance

 

>Counselors-Psychologists in northern Illinois

 

MarriageCounseling and Individual Therapy

 

> Counseling: Injury and Car Accident Trauma

 

>Telephone Counseling

 

>Articles: Mental Health and Counseling

>Anger Management and ADHD

> Depression and Anxiety Articles

> Up-to-the-Minute News

>More Info>www.caryilcounseling.com

 

 

New Patient Registration

Psychology and Counseling

Listed in the provider directories of:

Aetna-Allied

Aetna Behavioral Health

ValueOptions

Cigna

Coventry

Blue Cross Blue Shield PPO

Unicare

United Health

United Behavioral Health

Cigna Behavioral Health

PPO Next

Private Health Care Systems (PHCS)

Humana-Military

Multiplan

First Health

Humana

Tricare

Medicare

Beech Street

ChoiceCare

CAPP

Union Local plans

School District plans

HFN

Preferred Mental Health Management (PMHM)

Mental Health Network (MHN)

Magellan Health

Healthstar

ComPsych

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INCLUDED IN:

the Mental Health Provider Directory

the Provider Directory

Most Employee Assistance Programs (EAPs)

All Motor Vehicle Insurers (for auto accident trauma)

All Workers Comp Programs (for work injuries)

and many more...

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Services for:

Panic Disorder

Post-Concussion Syndrome

PTSD

Addiction Counseling

Adult ADHD Treatment

Anger Counseling Management

Anorexia Bulimia Treatment

Counseling Management Stress

Anorexia Nervosa Treatment

Anxiety Treatment

Anxiety Management

Stress Management

Anxiety Depression Treatment Center

Psychiatric Hospitalization

Suicide Prevention

Center for Psychotherapy

Center for Counseling Services

Child and Family Counseling

Counseling Marriage

Centegra Horizons

Horizons Behavioral Health

Alexian Brothers Behavioral Health

Mental Health Counseling

Mental Health Treatment Center

Marital Counseling

Online Phone Counseling

Phone Counseling

Psychological Test

Teen Counseling

Psychiatry

Psychiatric Medication

Millon Clinical Multiaxial Inventory

MMPI

Social Security Disability

Workers Compensation

Victim of Malpractice

New Patient Registration

NAVIGATION MENU:

New Patient Registration


View Appointment Calendar

Map to Cary Office

Articles

How to Find the Right Counselor-the FIRST Time
Counseling Services
Marriage Counseling and Individual Psychotherapy
Counseling: Injury and Car Accident Trauma
Telephone Counseling
New Patient Registration
Counselors-Psychologists in northern Illinois
Algonquin, IL: Counseling Directory
Barrington, IL: Counselor Directory and Town History
Crystal Lake, IL: Directory of Counselors and Psychologists
Cary, IL: List of Counselors and Psychologists
Dundee, East or West, IL: Psychologists and Counselors
Fox River Grove: Directory of Psychologist-Counselors
Huntley: Counselors-Psychologists
Island Lake, Il: Psychologists and Counselors
Lake Zurich, IL: List of Counselors and Psychologists
McHenry, IL: Counselor Directory and Town History
Richmond, IL: Counselors-Psychologists
Wauconda, IL: Directory of Counselors-Psychologists
Woodstock: List of Counselors and Psychologists
Northern Illinois: Drug-Alcohol Treatment Locator
Articles: Mental Health and Counseling
Before Weight Loss Surgery: Your Psychological Fitness Exam
Marriage and Relationship Articles
Depression and Anxiety Articles
Articles: How to Find the Ideal Counselor for You
Substance Abuse: Alcoholism and Drug Addiction
Adoption and Birth Surrogacy Evaluations
Motor Vehicle Accidents, Job Injuries and PTSD
Miscellaneous Mental Health and Counseling Articles
Psychological Assessments for Law Practices
The Psychiatric Disability Office
Psychological and Independent Medical Examinations (IME)
"The Provider Directory:" Find a Counselor Covered by your Insurance Company
Up-to-the-Minute News
Contact Us
Links to Mental Health Services and Information

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In-Office Services are located in Cary, Illinois and are convenient if you're coming from: 

  • Algonquin,
  • Northern Kane County, Illinois
  • Cary,
  • Crystal Lake,
  • Lake-in-the-Hills,
  • Barrington,
  • Elgin,
  • Dundee,
  • Gilberts,
  • Fox River Grove,
  • McHenry 
  • Southern McHenry County Illinois

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Services:

Depression treatment

Couple counseling

Family and Marriage Counselor

Counseling Therapy

Counseling Services

Counselor Marriage 

Depression Treatment Center 

Divorce Counseling

Adolescent Counseling

Drug Abuse Treatment

Child ADHD Treatment

Drug Addiction Counseling

Eating Disorder Treatment 

Family Counseling

Drug Counselor

Relationship Counseling

Family Counselor

Family Psychiatric Treatment

Psychologist 

Psychiatrist 

Bipolar Treatment

Anxiety Treatment

ADHD Treatment

Anxiety Disorder Treatment

Pre-Marriage Counseling

Pre-Marital Counseling

Obsessive-Compulsive Disorder

OCD

Behavioral Medicine

Personality Testing

ADHD Testing

Counselor Psychotherapist

Partial Hospitalization

Drug Treatment Program

Intensive Outpatient Therapy

Intensive Therapy

Bereavement Counseling

Grief and Loss

Geriatric Psychotherapy

Geriatric Psychology

Geriatric Psychiatry

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More Services:

Post-Traumatic-Stress Disorder

Alcoholism Treatment

Psychological Counseling

Psychiatric Treatment

Cognitive-Behavioral Therapy