We are looking forward
to connecting with you.

To request an appointment please fill out the short form below or you may contact us at (847) 906-3092. If this is an emergency, please call 911 or visit your nearest emergency room.

Your Name

First Name

Last Name

Name of Client (if different from above)

Age of Client

Phone

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Please give a brief summary of what you are willing to work on in therapy.

Most clinicians at The Balanced Center are in network with Cigna and Blue Cross Blue Shield PPO. Please let us know if you need a provider in one of these networks, or if you have other insurance. *Note: if you have insurance other than the two listed, we provide monthly statements you can submit to your insurance for out-of-network reimbursement.

Please select

I would like a provider in network with Cigna or BCBS.

I do not have Cigna or BCBS and understand my sessions will be considered out of network.

I am flexible and willing to see a clinician who is not in network if that expedites my ability to get help.

How did you hear about us?

Preferred date and time

We are looking forward to connecting with you.

We are looking forward
to connecting with you.