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Request an Appointment
Request an appointment one of our three skilled trauma-informed therapists.
Request an Appointment with a Therapist
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Name
*
First
Last
Phone
*
Preferred Time
*
Between 8 AM and Noon
Between Noon and 4 PM
Between 4 PM and 8 PM
Please check any applicable boxes
*
Active Street Involvement
Justice-System Involvement
Recent Victim of Violence
Family/Friend was a Recent Victim of Violence
Exhibits Violent or Aggressive Behavior (includes online)
Family Challenges and School Disengagement
If your neighborhood has been identified as having high gun violence
Anything you would like us to know or that you would like to know more about
*
Is this appointment being made by
*
Self
Guardian
Guardian Name
*
First
Last
Therapist preference:
*
Karissa Fleming, LCSW
Haydee Martinez-Rosales
No preference
Please be aware due to scheduling you may be paired with a different therapist than the one you selected.
Preferred language for therapy
*
English
Spanish
No preference
Disclaimer
Joliet Township is NOT an Emergency Department, please report any and all emergency situations to 9-1-1.
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