Next Steps & Insurance Verification Form

Review the available therapists listed below and complete the required fields before clicking submit.

Available Therapists

Clinician	Accepted Payment**	Client Focus
Na Tanya Cooper	BCBS Illinois PPO and Private Pay	Teens (13+) & Adults / Couples
Jamal Rashard	BCBS Illinois PPO and Private Pay	Teens (13+) & Adults
Nicole Langston	BCBS Illinois PPO and Private Pay	Teens (16+) & Adults
Anequa Blakely	BCBS Illinois PPO and Private Pay	Teens (13+) & Adults / Pre-Marital Couples
Jessica Black	BCBS Illinois PPO and Private Pay	Adults
Jillian Howard *Available starting June 8th	BCBS Illinois PPO and Private Pay	Teens (13+) & Adults
Andrea Horbrook *Available starting June 5th	BCBS Illinois PPO and Private Pay	Teens (13+) & Adults
Dr. Tia Layton	BCBS Illinois PPO and Private Pay	She specializes in treatment plans that require medication Teens (13+) & Adults
Upcoming 2023 Groups Women’s Wellness Collective: Sister Circle for Black Women (Wednesdays 6:00 pm - 7:15 pm) First Generation College Student Support Group	Private Pay, $200/mo for weekly 75-minute closed group sessions	Adults

*Our 2nd-year graduate interns provide low-cost quality mental health services for those willing to pay out of pocket at the rate of $30 per session. Our interns do not do consultations, but your first session is free if you choose to work with our interns.

**Only available clinicians and insurance are listed as options on this page. If you do not see your insurance, then we do not accept that insurance, or there is no clinician available that accepts that insurance.

PRIVATE PAY RATES

$150 per session for individuals
$170 per session for families and couples
$225 for a medication consultation
$175 for medication management

Client Information

Name*

First NameLast Name

Date of Birth*

Date

Phone Number*

Area CodePhone Number

Email*

example@example.com

Your Preferred/Available Therapists or Group

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If I choose to schedule recurring services, I'd like to offset/cover payment with*

I'd like to schedule...*

A Consultation (not available for intern clinicians)Recurring ServicesTo be added to the Waitlist for the clinician selected

Sponsoring Company*

Lyra Code

USHIP Referral Form (Optional)

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Front Side of Insurance Card*

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Back Side of Insurance Card*

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EAP Letter Upload*

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Message / Comments / Note (Optional)

I understand due to Illinois state rules, that in order to receive in-person or virtual therapy services at Reclaiming Minds Therapy I must reside in Illinois at the time of services.*

I Understand

Schedule a Session

Review the available therapists listed below and complete the required fields before clicking submit.

Available Therapists

Client Information