Name *

First Name

Last Name

Phone Number *

Country

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I'm interested in... *

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Consulta en español

Couples Counseling

Premarital Counseling

Individual Relationship Counseling

Dance/Movement Therapy

Therapeutic Couples Dance

Therapeutic Wedding Dance

Day of the Week to Book Consultation

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Tuesday

Wednesday

Thursday

Friday

Saturday

Time of Day

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Morning

Afternoon

Evening

Type of call *

Phone call

Video call

This is a private pay practice and insurance is not accepted. I have read the FAQ's and understand that the fee is $195.00, paid at time of service. I will receive a Superbill if using my out-of-network benefits. As a courtesy of this practice, I can easily review my benefits and submit claims for FREE through Reimbursify. *

Yes, I understand.

All sessions are offered in the office located at 6007 N. Sauganash Ave. in Chicago. Teleheath appointments are available only as needed. *

Yes, I understand.