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Request Appointment

NOTE: Appointments requests are sent as request only and you will be contacted by our Intake Coordinator within 24-48 hours to get you matched with a therapist to meet your needs. 
If this is an emergency, please call 911 or go to your nearest emergency room.

New PatientExisting patient

Name*

Age

Child under 12AdolescentAdultSenior

Phone*

E-mail

Are you seeking services for:

YourselfYour childFamily memberOther

Reason for Seeking Services

Telehealth is available but for in-person services, which location is preferred?

Crystal LakeSchaumburgGlen Ellyn

Insurance Carrier

Any other information you want us to know?

Thank you!

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Contact Information

Office Locations:
N. Plum Grove Rd, Suite C, Schaumburg, IL 60173

Pingree Rd, Suite 210, Crystal Lake, IL 60014 

Roosevelt Rd., Building A, Suite 321, Glen Ellyn, IL 60137

Phone: 847-413-9700
Fax: 847-413-1701

E-mail: admin@personalgrowthassoc.com

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