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Request An Appointment


Preferred Contact Method*
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For new clients, please describe what is bringing you in for an appointment. If you have a mental health diagnosis or other health concern we should be aware of, please mention it here. For current clients, please include what provider you would like to make your appointment with, as well as any other information you would like to share.

Are you currently in crisis?*
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Get Help Now »

If you are currently in crisis, we want to help you right away! Please call us:

Illinois (toll-free): 855.985.0911

Indiana (toll-free): 800.832.5442

Tennessee (toll-free): 800.681.7444


Additional Information

Where would you like to be seen?

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Insurance Provider

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Your privacy is deeply important to us. This form is secure so that only our call center staff will see the information provided, and they will only use it to schedule your appointment. Click here to learn more about our privacy practices.