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New Client Inquiry

Please complete the secure form below. Our clinical team will review your information and reach out within 24–48 business hours to discuss the next steps.

Call us at (708) 840-8516 or email info@balanceandentitywellnesscare.com.

Name

Email Address

Phone

SelectIllinoisIndiana

How can we help?

How can we help?Individual Therapy (IL/IN Residents)DOT SAP Evaluation (Scheduling for June)Clinical Supervision / ConsultationGeneral InquiryFamily or Group therapy IL

How do you plan to pay for services?Self-PayBlue Cross Blue Shield (BCBS)AetnaCigna/EvernorthOther (Please specify in message)

Privacy Disclaimer

This form is for general inquiries. For your privacy, do not include sensitive medical details or Social Security numbers. Once we connect, you will receive an invite to our secure Spruce portal for all clinical intake and documentation. 

Once we receive your inquiry, we will invite you to our Spruce Secure Patient Portal. Please look for an email or text invitation from Balance and Entity Wellness Care. This ensures your clinical data and documents remain 100% encrypted and HIPAA-compliant.

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Important Notice:

Confidentiality: Please do not include highly sensitive clinical details in this form. Specific substance use disorder information is protected by 42 CFR Part 2.
Crisis Information: Balance and Entity Wellness Care is not an emergency or crisis intervention service. If you are experiencing a life-threatening emergency, please call 911 or go to your nearest emergency room. You may also contact the National Suicide & Crisis Lifeline by dialing 988.

Secure Texting Available: You may securely text our practice at (708) 840-8516 for quick scheduling inquiries.