The first step starts here

We’d love to hear from you.

Get in touch

Clinic: (847) 807-1822

Fax: (847) 787-1313

Whether you’re curious about services, have a question about the practice, or are ready to take the first step toward healing, please reach out. We’ll respond with care and clarity, and if it feels like the right fit, we’ll guide you through the next steps.

COMPLETE THE FORM BELOW AND WE’LL BE IN TOUCH SOON.

Name

First Name

Last Name

Phone

(###)

###

####

Age

Do you currently live in Illinois?

Yes

How did you hear about us?

Briefly, what motivated you to seek a consultation?

Are you a TRICARE beneficiary?

Do you have a primary or secondary Medicare or Medicaid policy?

When are you available for the consultation call?

Acknowledgment

By requesting this consultation, I acknowledge that Curious Minds is an out-of-network practice and does not accept Medicare, Medicaid, or commercial insurance. I have reviewed and understand the fee schedule for services at Curious Minds. Payment is required at the time of service. This consultation request form is confidential. In compliance with the Health Portability and Accountability Act "HIPAA" (rule 104-91), please know that communications over the Internet are not guaranteed to be secure. There exists a possibility that the information you include in this form can be intercepted and read by other parties besides the staff at Curious Minds. If you are concerned about this, you can always text the words “HIPAA concern” to (847) 807-1822 to get registered with our secure messaging system

I acknowledge and agree to these terms.

Please Note:

*This form is not for urgent matters or clinical advice. If you're experiencing a mental health emergency, please call 911 or go to your nearest emergency room.

*We recommend reviewing our fee schedule before submitting your inquiry.