CFS 431-1: Mental Health Treatment Request

Please read the instructions below prior to completing the request. Failure to follow instructions may result in a processing delay.

Instructions:
This form should only be completed by a DCFS Caseworker/Supervisor or a Child Welfare Contributing Agency. If you are requesting a Psychological Evaluation, a CFS 417-C form signed by a DCFS Consulting Psychologist is required. If you have your own internal consent form needing review, please include it as an attachment with your submission. Do not use acronyms anywhere in the request.

Form Submission

Requestor Information

First Name

Last Name

Please use an Illinois.gov email if possible. The completed consent will be returned to this email.

Phone Number

Please provide a direct phone number, and phone extension if applicable, where the requestor can be reached in case additional information is needed to process the request.

Phone Extension

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Fax

Office of the Guardian - Consent Unit

Office of the Guardian - Consent Unit