Contact

Address

1602 W. Colonial Parkway, Suite 200, Inverness, IL 60067

Contact

847-364-0163

referrals@serenitycounselinglkn.com

Hours

Mon - Fri

9:00 am – 5:00 pm

Therapists schedule appointments from 9am to 7pm Monday - Friday, depending on availability, and some therapists offer weekend hours.

First name

Last name

Email

Phone

Preferred Method of Contact

Phone

Email

Text

Referred by a Provider:

Yes

No

If you were referred by a provider please add your provider name, practice/clinic, phone, and email.

Do you have Insurance?

Yes

No

If you do have insurance, please provide the following:

Member ID

Group number

Primary insured name

Primary insured date of birth

Please upload images of the front and back of your insurance card:

Front of card

Back of card

Is there a certain Therapist you'd like to work with?

Location Preference:

Inverness

Skokie

Telehealth (Illinois residents)

Additional Notes:

I consent to be contacted by Serenity Counseling and Wellness about services and scheduling. Note: Submitting this form does not create a therapist-client relationship.

Contact

Address

Contact

Hours

Inverness, Illinois

Skokie, Illinois