TWWC New Client Intake 

Thank you for your interest in therapy with The WOTI Wellness Collective, PLLC. Selecting a therapist is an important decision and we admire your courage in taking the first steps towards achieving your goals and obtaining the support you deserve. Our desire for you is a smooth start process, so we've explained everything you need to know to move forward below. 

We offer virtual individual counseling services to Illinois residents. We accept both health insurance and self pay. Currently we accept the following insurance plans: Blue Cross Blue Shield PPO, United Health Care PPO, Aetna PPO and Optum. Sometimes smaller insurance plans fall under a larger umbrella insurance company, so if you are unsure, we are happy to check and verify. Our self pay rate is $165 for initial diagnostic intake and then $140 per subsequent sessions. Unfortunately, we are not accepting medicaid plans at this current time. 

Once you've completed this intake form, within 48 hours, you can expect to receive (1) an email from our biller, Headway or Alma, prompting you to make a profile and (2) a link to your virtual client portal. Once your portals are complete, you'll be able to confirm your first session. 

We look forward to working with you! 

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Email *
What's your legal name (first and last)  *
What's your date of birth? *
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What's the best number where we can reach you?
What's your availability for therapy?  *
Anything else we should know about your schedule?
Insurance Type? (Please Note: Intake coordinator will require copy of ID and Insurance Card) *
Please share your Insurance ID and Group Number to expedite verification process. 
What is the address associated with your insurance? (required for verification)
What led you to seek support? Please briefly describe your therapy goals.  *
How did you hear about The W.O.T.I. Wellness Collective? 
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