Appointment Request

Schedule An Appointment

Please complete the form below to schedule an appointment. We try our best to respond to your request ASAP.

*Please be sure to check your junk folder if you don’t hear from us.*

(773) 242-8898

[email protected]

930 N York Road Suite 150 Hinsdale, IL 60521

1959 DeKalb Ave Suite A, Sycamore, IL 60178

2128 Midlands Court Unit 105 Sycamore, IL 60178

Name *

Email *

Phone

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Would you like to opt-in to receive text messages from Back to Balance Counseling? Opt-in is optional. By opting-in you agree to receive recurring text messages regarding appointment reminders and scheduling, billing, insurance, etc. Message frequency varies. Message and data rates may apply. For help and support call 773-242-8898 or email [email protected]. Reply STOP to any text message you receive from Back to Balance Counseling to opt-out at any time. For more information, visit our privacy policy at Back to Balance Counseling or our terms and conditions at https://backtobalancecounseling.com/wp-content/uploads/2025/06/privacy-policy.pdf

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By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.