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Galena Clinic from across the street

Galena Clinic

939 Galena Square Drive
Galena, IL 61036
Call 815-777-1300
Fax: 815-777-1308

Start Here
STEP 1: Get and fill out your forms

Download your Consent for Services form Here

This form explains Your Rights

Download and fill out the Release of information

Download and complete The Intake Form

You have the choice to either fill out the forms on your computer or print and scan them.

STEP 2: Deliver your forms to Galena Clinic

You may:

Bring your forms with with you to your first session, or

fax them to 815 777-1308, or

you may upload them to our file service.

If you choose to upload your forms.
Fill out the fields below. After you hit submit, you'll be given instructions on the next page.
Please complete all fields marked*

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