Telehealth & Contact


Mindful Life Counseling provides services exclusively through telehealth.

Contact Us

Please fill out the information below; your message is a priority to us and we will make every effort to respond within 24 hours.

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    First Name*

    Last Name*

    Preferred or Chosen Name (Optional)

    Pronouns (Optional)

    To support you in connecting with a culturally responsive therapist, please share your racial, ethnic, and/or cultural background (Optional)


    Phone Number*

    How Did You Learn About Us?
    Internet SearchTherapy for Black GirlsTherapy for Black MenInclusive TherapistsPsychology TodayFamily or FriendPhysicianOther

    If 'Other', Please Specify:

    Preferred Therapist*


    If 'Other' Insurance, Please Specify:

    Name on Insurance Card*

    Date of Birth for Name on Insurance Card*

    Insurance Member ID #*

    Acknowledgment: Illinois Services*
    I acknowledge that I am seeking services while in the state of Illinois.

    Acknowledgment: Telehealth Services*
    I acknowledge that Mindful Life Counseling provides services exclusively through telehealth. I understand that all sessions will be conducted remotely, using telecommunications technology, and I consent to receiving services in this format.

    Your Message


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