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If HMO, medical group *
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*required information.

If you will NOT be using your insurance company or have no insurance please write 'none' in the Insurance Company box.

Someone will contact you via phone or email usually within 24 hours. If you would like to schedule an appointment ASAP, please call 815.577.8970 ext. 201.

Thank you for your interest in what Heritage Counseling Center can offer you.

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