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Thrive in Therapy for Teens Client Registration Form

Thank you for your interest in receiving mental wellness care at Sista Afya Community Care through our Thrive in Therapy for Teens program. We recommend using a desktop or laptop to complete this form - Do not use a phone. Please take 10 minutes to fill out this form for teen therapy. Please have your photo ID, proof of income, or insurance card, ready to upload to this form for proof of Illinois residency. Lastly, make sure that you schedule your 15-minute phone intake at the link this link: https://calendly.com/saccintake If you forget this step you will not be able to complete the process to begin therapy.

Reduced Eligibility: Caregivers must make less than $3000 a month or receive public assistance.

Insurance Accepted: Blue Cross Blue Shield PPO, Cigna, United Healthcare, and Aetna PPO. If you have any questions, feel free to reach out to us at: [email protected].