Loop Location
30 N Michigan Ave, Suite 424
Chicago, IL 60602
Phone: 312-279-9981
Fax: 312-279-9981

Lakeview Location
3209 N Lakewood Ave
Chicago, IL 60657
Phone: 312-279-9981
Fax: 312-279-9981

Intake Form & Insurance Verification

If you’re ready to take the first step towards wellness, please fill out our intake form & insurance verification forms below:

Intake Form

We also know how hard it is to reach out and get started with a therapist. We are committed to doing everything we can to make your next steps as easy as possible. Our team is available for consultation about what service, or combination of services, will align with your individual goals to navigate your best life.

Insurance Verification Form

Please complete this FORM to have your insurance verified or update your insurance, if it has changed since the onset of your treatment at MBC. Diana Quezada will verify your benefits & email you within 3 business days.

Billing Questions

Lisa Avrett our billing manager is available to answer any of your questions. Send her an email or leave a message, and she will return your call within 3 business days.

email:  billing@mindbodycoopchicago.com

Phone: 312-279-9981 x6.

Faxing Documentation

For faxing documentation to Mind Body Co-op, (ex. record requests, insurance provider requests, discharge summaries, etc.) please send documents to (312)-279-9981

Medical Records & Form Completion/Letter Requests

For support with Medical Record requests, please complete this Form and a member of our Client Relations Team will get back to you within 5 business days.

We’re looking forward to hearing from you and having the opportunity to help you heal. Chat soon!

– MBC Healing Team

Mapping Your Road To Wellness