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  411 Business Center Dr. , Mt. Prospect STE 114, 855 E. Palatine Rd. Palatine STE 250 Phone 847-504-9521

Intake Forms and Procedures

Once you have called to schedule an appointment or filled out the appointment inquiry on our main page, please do the following:
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1. Fill out the intake form and send to holisticbehavioral@gmail.com
2. Take a picture of your drivers license as well as the front and back of your insurance card and email to holisticbehavioral@gmail.com
3. Wait to hear from our office administrator or a clinician about setting up your first session

Thank you so much, we look forward to hearing from you. 
Holistic Behavioral Health Staff
INTAKE FORM
CANCELLATION POLICY
RELEASE OF INFORMATION PDF
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  • HBH
  • Intake Forms
  • Counseling Services
  • Contact Us/Location
  • Payment Options
  • Clinicians