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Next Level Counseling and Wellness

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New Client Request!

Request an Appointment

Please fill out the following form to help us understand how we can best serve you.

Waiting Room

First Name

Last Name

Guardian First Name (if applicable)

Email

Phone

What is the age of the client?

Insurance Provider or Self Pay?

What is your appointment availability? *

Daytime Preferred

Evening Preferred

Weekend Preferred

Open Availability

Session Preference: *

Virtual

In-office Chicago

In-Office Crystal Lake

In-Office Woodstock

What else do we need to know?

Thank you! We will be in touch shortly!

Info@NLWell.org

Phone: (815) 575-8860

Fax: (815) 668-8955

Chicago

3525 W. Peterson Ave., Ste 403

Chicago, IL 60659

Woodstock

226 W. Judd Street, Suite C.

Woodstock, IL 60098

Crystal Lake

44 N. Virginia St, Suite 2A

Crystal Lake, IL 60014

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