Thank you for considering Empowering Minds for your psychiatric and/or mental healthcare.
We are currently scheduling two weeks out for new patient appointments. In order to provide quality and efficient care for your individual needs, please provide the information requested below. This information will be used to ensure patients and providers are a great match for care.
Once submitted, please expect a call from us within 48 business hours.
In an attempt to remain HIPAA compliant and within guidelines, please only complete this form if you are requesting contact for yourself or as a direct family member of the intended client. If you are provider or medical office, please submit referral with demographic information via secure fax at 815-324-5102 or have your patient contact us directly.
We look forward to connecting with you!
