Main Website - Get Started

Not sure if you’re covered? Our team can check for you! Please note that we are not able to accept Medicaid or out-of-network private insurance plans.

Name*

First NameLast Name

Child's Name

First NameLast Name

Email*

Phone Number*

Child Age*

Zip Code*

Preferred Location*

Services Requested

Primary Insurance*

Insurance Type*

Since you selected Medicaid as the type of insurance, please let us know if any of the special circumstances below apply to you. This allows our grants department and outreach department to better assist in determining if we can help with services.

A member of our outreach department will be in touch either way!

Since you selected No Insurance as the type of insurance, please let us know if any of the special circumstances below apply to you. This allows our grants department and outreach department to better assist in determining if we can help with services.

A member of our outreach department will be in touch either way!

Do you have additional insurance coverage?

YesNo

Have you recently lost private insurance through your job or for any reason (e.g., covid, laid off, etc)?

YesNo

Have you recently moved to Illinois within 60-days?

YesNo

Have you recently had a baby or got married within 60-days?

YesNo

GCLID

Please verify that you are human*