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Our office is currently operating as a hybrid practice with both in person and Telehealth options available. In office appointments are located in the Downtown neighborhood of Chicago at 53 W. Jackson Blvd.

We’re a fee for service practice and are not contracted with insurance except for BCBS PPO and BlueChoice PPO. We’re happy to provide statements that you may submit to your insurance for reimbursement as well as complete any necessary paperwork to help facilitate reimbursement for your appointments. Please check our FAQs page for more details on contacting your insurance to check your out of network benefits.

Have questions? Give us a call at 773-309-1542 or send us an email at hello@embodyandmindcollective.com

Appointment Request for Embody + Mind Collective

Name

First Name

Last Name

Phone

(###)

###

####

What are your pronouns:

Date of Birth

YYYY

We are located at 53 W Jackson Blvd. in Chicago, IL, as well as a virtual office in Indiana and are currently offering both in-person and telehealth/video appointments. Would you prefer:

Which provider do you prefer to see?

What state are you located in?

Insurance

We accept BCBS PPO, and Blue Choice PPO Plans . See our FAQ page for out-of-network info. Note: We are not in-network with Medicaid (including Aetna Better Health & Blue Cross Community Health) and cannot accept Medicaid-enrolled clients.

Please tell us a little bit about what you're looking for support with:

Tell us a little bit about what works best for you as far as a therapist's interaction style (i.e. I'd I prefer to work with someone who is direct, offers feedback, is compassionate, nurturing, etc.) You can reference what you have liked or not liked about working with therapists in the past if applicable:

Are you currently experiencing any of the following:* ***IMPORTANT NOTE*** This form is not a substitute for crisis support. If you are feeling unsafe, or experiencing a psychiatric emergency, please call 911 or visit your local emergency room.

Thoughts of hurting yourself or someone else

Active substance abuse

Legal issues (arrest history, DCFS involvement, court mandated therapy, etc.)

None of the above

If you endorsed any of the above, please describe here. If you checked "none of the above" simply write n/a here.

COntact Us

Appointment Request for Embody + Mind Collective

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