Thank you for your interest in receiving therapeutic services at Sista Afya Community Mental Wellness. You must be a permanent Illinois resident to receive therapy. We recommend using a desktop or laptop to complete this form.
Please take 10 minutes to fill out this form for those paying for therapy with Insurance and self-pay at our full rate. Please have your insurance information ready to list your member ID, group number, and upload a picture of the front and back of your insurance card. At the end of this form, you must schedule a 15-minute intake session to schedule an appointment, review therapy policies, and answer any questions you have.
ATTN: We do not provide therapy for couples and families. If you are looking for a couple's or family therapist, please review our Preferred Providers List at: http://bit.ly/afyaresources
If you have any questions, feel free to reach out to us at: therapy@sistaafya.com . NO PHONE CALLS PLEASE!