Steven M. Yousha,
Psy.D., LCSW

Licensed Clinical Psychologist
Licensed Clinical Social Worker
Organizational Psychologist

(773) 381-1111


2603 Broadway Ave.
Evanston, IL 60201
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Office Hours by Appointment ©2022 Steven M. Yousha
Dr. Yousha

Dr. Steve Yousha is a Psychologist and Senior Consultant who has been practicing since 1990. In addition to his clinical practice, he is Principal at Strategic Talent Management Consultants LLC.

Client Intake Forms

Prior to the first session, please complete the following paperwork and consent forms. To simply print the complete packet, choose the first link below. If you only need certain forms, they are listed individually as well. Please print documents single-sided.

The ROI (Release of Information) form is to be completed if you have seen another mental health professional during the past 2 years.

Should you have any questions about the forms or consents, please do not hesitate to ask for clarification.

Complete packet (includes all forms listed below)

Complete Packet of Forms

Individual forms (included in packet above)

Private Practice Facesheet

Psychotherapist–Patient Services Agreement

Illinois HIPAA Notice Form

Intake Form

Electronic Communication Consent Form

Credit Card Authorization Form