Dirksen Center Resources
Did you know that our emotions affect our physical health, and our physical health affects our emotions? They’re not distinct things as people once thought!
Below is a list of forms you can download and fill out to expedite your first visit at The Dirksen Center.
Consent for In-Person Services (download)
Dr. Courtney Dirksen Electronic Form Bundle (download)
Dr. Tria Murphy Electronic Form Bundle (download)
Dr. Susan Klostermann Electronic Form Bundle (download)
Dr. Lisa Sorensen Electronic Form Bundle (download)
Dr. Karen Burcham Electronic Form Bundle (download)
Demographic Form (download)
Pediatric Update Form (download)
Pediatric Questionnaire (download)
Discharge Guidelines For Pediatric Brain Injury (download)
Alternate Caregiver Consent Form (download)
Authorization for Release of Confidential Information from DCN (download)
Authorization for Release of Confidential Information to DCN (download)
Authorization for Exchange of Confidential Information (download)
- Centers for Disease Control and Prevention – website on a type of traumatic brain injury caused by a bump, blow, or jolt to the head which can range from mild to severe. Discusses signs and symptoms, what to do to, prevention, and additional information and resources.
- Medline Plus, a service of the US National Library of Medicine and National Institute of Health gives an overview of brain concussions, a common type of sports injury, or if you suffer a blow to the head, or hit your head in a fall.
- Mayo Clinic – Mayo Clinic website on the definition, symptoms, causes, risk factors, complications, tests and diagnosis, treatments, and drugs, as well as prevention of concussions.
- TBI Rack Card (download)
- The Autism Society of Illinois (630-691-1270) also provides educational services and support for families dealing with children on the spectrum of autism.
- For web information regarding autism spectrum disorder, we recommend www.autismspeaks.org for current, reliable and valid information.
- KGH Autism Services
- Amita Health Autism Resource Center
When you laugh your brain is working overtime. So next time you laugh think about this…five different areas of your brain all need to work together to get that laugh out.
Please call our office to make a payment by credit card or send payment via Zelle to [email protected]