Insurance and Forms


Lotus Wellness Center

Private Pay

We take private pay clients who do not have insurance. Since we provide multi-disciplinary approach with varying services, please contact us directly to discuss private pay fees.

We are currently accepting:

  • BlueCross and BlueShield (BCBS) PPO
  • Aetna
  • Cigna
  • Humana
  • Magellan Behavioral Health
  • Optum/United Healthcare
  • Out of Network
  • Smart health
  • Medicare

Some insurance offers Out-of-Network benefits for our providers. We are happy to check your specific benefits pertaining to our treatment codes at no charge or obligation to you.

Schedule of Fees & Late Cancellations

All clients begin with a 50-minute initial consultation with a counselor. Thereafter, clients schedule standard, weekly/biweekly sessions with their counselor. You are responsible for all fees at the time of service; cash, credit card, and personal checks are accepted. Any unpaid balance may be turned over to a collection agency if you refuse to remain responsible for your account. You will be expected to pay for late cancelled or forgotten appointments with a $50 charge, unless there has been an emergency or at least notice of cancellation given within 24 hours. The fee must be paid at your next appointment. There will be a $30 charge for any checks that are returned for insufficient funds.

Client records and Court Appearances

We do not make it a normal part of our counseling practice to be involved in court cases. As a client you are welcome to a copy of your client records. Copies of records will be charged at $25.

Contact Us

Lotus Wellness Center
1292 W Northwest Hwy
Palatine, IL 60067
773-897-3292


CLIENT FORMS

We believe that the majority of your first visit should focus on a discussion of your needs and expectations in order to gain a better understanding of the clinical picture as well as collaborative treatment planning. Please take some time to read and fill out each form that is relevant to your care. If you are not able to print out and complete the forms prior to your session, please arrive 15-20 minutes earlier to get started on the forms.


If you are seeking counseling and/or hypnotherapy services, please print and complete the following:


If you are participating in a psychological testing session, please print and complete the following:


If you are participating/receiving chiropractic care, please print and complete the following: