Welcome to Taylor Healing Institute

We are Taylor Institute for Healing, Learning, and Change. 

We offer a unique blend of traditional therapy and holistic practices to help you overcome personal obstacles, heal from trauma, and navigate grief and loss. Discover how our nurturing and attentive approach can support you in uncovering a deeper understanding of yourself and create lasting positive change.

In addition to our therapeutic services, we provide executive coaching to enhance personal and professional growth, helping you achieve your goals and overcome challenges with tailored support. For clinicians in Illinois working towards licensure, we offer clinical supervision to guide and support your development as a practitioner.

Our comprehensive services are designed to address various aspects of your well-being and professional journey, ensuring you receive the support you need to thrive.

Instructions:

  1. Please take 5 minutes to complete your initial assessment form. This form is designed to help us understand your needs and tailor our services to best support your journey.

  2. Fill out each section as thoroughly as possible. Your responses will remain confidential and ensure that we can provide the most effective support.

  3. Once completed, submit the form through the provided link. If you have any questions or need assistance, feel free to contact us.

Thank you for taking the time to complete this form. We look forward to working with you!

Sign in to Google to save your progress. Learn more
Full Name - First and Last  *
Date of Birth *
MM
/
DD
/
YYYY
Phone Number *
Email Address *
What is your preferred method of contact?  *
By checking one of the following you are consenting to being contacted in that way
Required
Home Address (include city, state, and zip code) *
Service Type *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Taylor Healing Institute.

Does this form look suspicious? Report