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Online Appointment Request

Appointment Request – Chicago Mental Health Services

Open Avenue – (312) 344-3184
*Insurance Verification Form

Request a session with one of our therapists. Let us know what time you’re available and what you’re hoping to gain from therapy.


Phone Number*

Client Email*

Select Therapist - 1st Choice*

Select Therapist - 2nd Choice*

First Choice Date/Time*

Second Choice Date/Time*

Have you been to therapy before?*

Anticipated length of treatment?*

Reason(s) for seeking therapy. What are you hoping to gain?*

File Upload (if needed)


*Note: If you intend on using insurance for treatment you must fill out the insurance verification form at least 48hrs in advance of your scheduled appointment.