Book An Appointment — Chicago Integrative Psychotherapy

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We know starting therapy can be a difficult and hard process. We will do our best to reach out to you within 24 hours of your submission. Please feel free to call us at (773) 887-2239‬ or email us at contact@chicagointegrativepsychotherapy.com if you have any additional questions.

Name

First Name

Last Name

Email

Phone

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What services are you interested in?

Individual Therapy

Couples Therapy

Please provide your address.

Address 1

Address 2

City

State/Province

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Date

What is your date of birth

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Who is your insurance provider? (We are currently in Network with BCBS and Aetna)

What is your insurance member ID number? (Please type N/A if you aren't using insurance)

What is your insurance group ID number? (Please type N/A if you aren't using insurance)

What is your availability for appointments? Please provide as many options as possible.

In a few words please let us know what we can help you with. This will help us place you with a clinician who will be the most helpful for you.

Is there a specific clinician you are hoping to see?

Are you looking for in-person sessions or virtual sessions?

In-Person

Virtual

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Hours