Social Media Policy:

This document outlines my office policies related to use of Social Media. Please read it to understand how I conduct myself on the Internet as a mental health professional and how you can expect me to respond to various interactions that may occur between us on the Internet. If you have any questions about anything within this document, I encourage you to contact me or bring them up in session.


My policies on social media can be found here:



Confidentiality Policy & Limits to Confidentiality:

The law protects the privacy of all communications between a patient and a psychologist. In most situations, I can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA and/or Illinois law. However, in the following situations, no authorization is required:


1) I may occasionally find it helpful to consult other health and mental health professionals about a case. During consultation, I make every effort to avoid revealing the identity of my patient. The other professional are also legally bound to keep the information confidential. If you don’t object, I will not tell you about this consultation unless I feel that it is important to our work together. I will note all consultations in your Clinical Record (which is called “PHI” in my Notice of Psychologist’s Policies and Practices to Protect the Privacy of Your Health Information).


2) Disclosures required by health insurers or to collect overdue fees are discussed elsewhere in this Agreement.


3) If you are involved in a court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the psychologist-patient privilege law, I cannot provide any information without your (or your legal representative’s) written authorization, or a court order. If you are involved in or contemplating litigation, you should consult with your attorney to determine whether a court would be likely to order me to disclose information.


4) If a government agency is requesting the information for health oversight activities, I may be required to provide it for them.


5) If a patient files a complaint or lawsuit against me, I may disclose relevant information regarding that patient, in order to defend myself.


6) If a patient files a worker’s compensation claim, I must, upon appropriate request, provide appropriate information, including a copy of the patient’s record, to the patient’s employer, the insurer or the Department of Worker’s Compensation.


There are some situations in which I am legally obligated to take actions, which I believe are necessary to attempts to protect others from harm and I many have to reveal some information about a patient’s treatment. These situations are unusual in my practice and are as follows:


1) If I have reasonable cause to believe that a child under age 18 is known to me in my professional capacity maybe an abused child or a neglected child, the law requires that I file a report with the local office of the Department of Children and Family Services. Once such a report is filed, I may be required to provide additional information.


2) If I have reason to believe an elderly or handicapped individual in a domestic situation has been abused or neglected in the preceding 12 months, the law requires that I file a report with the agency designated to receive such reports by the Department of Aging. Once such a report is filed, I may be required to provide additional information.


3) If you have made a specific threat or violence against another or if I believe that you present a clear, imminent risk of serious physical harm to another, I may be required to disclose information in order to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking your hospitalization.


4) If I believe that you present a clear, imminent risk of serious physical or mental injury or death to yourself, I may be required to disclose information in order to take protective actions. These actions may include seeking your hospitalization or contacting family member or others who can help in providing protection.


If such a situation arises, I will make every effort to fully discuss it with you before taking any action and I will limit my disclosure to what is necessary.

Intake Paperwork:

The following forms are required and to be completed before the initial intake appointment. Completing the forms prior to your appointment helps us maximize the entire session time to discuss the reason for your referral.


Forms can be downloaded, printed,  and completed by clicking the buttons below:

Policies & Forms



Megan Pietrucha, Psy.D., LLC

Licensed Clinical Psychologist & Sport Psychology Consultant