Contact - Creating Space Therapy

First & Last Name*

Email*

Phone Number*

Whom are you seeking counseling for*

Self

Child

Teen

Other family member

Are you looking to work with a specific therapist or are you open to first available?

First available

Charlotte Shuber

Kelly Huggins

Lydia Gedmain

Thelma Razo

Tracy Teichman

Briefly describe the issue you would like to work on. *

What’s the best way to contact you?

Text

Email

Phone call

What is your insurance, if you are planning on using?

What location are you needing?

Naperville

Geneva

I’m open to telehealth

Please list two days and times that you would be available for therapy sessions.*

How did you hear about us?

Email Risk Acknowledgement and Use Consent

Email Text*

I understand that the use of email and SMS text messages are inherently insecure and thus poses a risk to the security and confidentiality of my protected health information and I consent to Creating Space Therapy therapists and/or office staff communicating with me via email or text message

Privacy Policy

I have read and agree to the Privacy Policy

Newsletter

Yes, I would like to subscribe to the Creating Space newsletter

Contact Us

Request a Consultation Call