First Name

Last Name

Phone Number

Email Address

Service Requested Service Requested EMDR and Trauma Therapy Art Therapy Mindfulness Family Therapy Couples Therapy LGBTQ Issues Play Therapy Marriage Counseling Premarital Counseling Child & Adolescent Therapy Divorce Mediation

Location Requested Location Requested Telehealth (available throughout Illinois) In Person (available in Algonquin)

Tell us a bit more about why you are seeking services.