Contact Form

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Contact Form

Taking the first step is hard, but our therapists are here for you. Please fill out the form and a member of our team will be get back to you as soon as possible.

Are you an Illinois resident?* *

Please note that we only provide services to individuals who live in Illinois

Full Name *

Email *

Phone Number *

What Is Your Primary Reason For Seeking Therapy? *

What is Your Primary Insurance? We accept BCBS PPO, Blue Cross Community (Medicaid),BCBS Advocate HMO ( sites:099, 124, 294, 302, 331, 357, 398, 464, 474 & 600), United Health Care PPO, & Aetna PPO *

What Time Works Best for Appointments? *

Mornings (8AM-12PM)

Afternoons (12PM-4PM)

Evenings (4PM or later)

Weekends

I'm flexible (any time or time typically works for me)

Other:

Required

Which Therapist Would You Like To Meet With? *

Alice Solis, LCPC

Emily Halvorson, LCPC & Art Therapist

Esperanza Rivera, MA

No Preference

How Did You Hear About Us?If Doctor/Therapist: Name *

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