Thank you for starting your journey with Quantum. Please complete the form below:

Last Name *

Date of birth *

Email *

Cell/Home Phone *

First Name *

Currently, we only provide therapy services in Il, MO, & TX.

Below is a list, per state, of the insurance providers that we accept:

Missouri: Anthem, Blue Cross/Blue Shield, Cigna & Evernorth, Health Link, Optum, GEHA, United Healthcare UHC/UBH, AETNA, Missouri Medicaid (Momed), Homestate Health, Show Me Health Kids, Ambetter, & Medicare
Texas: Anthem, Blue Cross/Blue Shield, Cigna & Evernorth, United Healthcare UHC/UBH, Texas Medicaid and Medicare
Illinois: Anthem, Blue Cross/Blue Shield, Cigna & Evernorth, United Healthcare UHC/UBH, Medicaid, & Medicare

Do you have one of the above active and eligible insurance, been referred by the STL court program, Project THRIVE, STL VA EAP program, Centerstone's Military program, or do you have the ability to private pay? *

State *

If you are using insurance, please share the type. Please remember that we only accept the insurance listed above.

Please share insurance ID number

If private pay, do you have the ability to pay $150 per session?

What is your co-pay for behavioral health services?

Please upload a copy of your insurance card. (Front & Back)

Please share insurance Group ID number

What brings you to care? Please list your presenting concerns *

How did you hear about Quantum Consulting Group? *

Please upload a copy of a government ID *

If you are in a mental health crisis, please dial 988. If you are experiencing a mental health emergency, please dial 911 or go to your nearest emergency department.

Please sign for Quantum to check eligibility and start the behavioral health process. *

Clear

I agree to the terms & conditions provided by Quantum. By providing my phone number, I also agree to receive text messages from the Quantum.