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Apply For Therapy

If you are uninsured or underinsured and your insurance plan has a deductible that is too expensive for you to afford to obtain services, you may qualify for sliding scale therapy.

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If you make less than $1,700 a month you may qualify for Medicaid. To apply for Medicaid click here. Please note that Everyone's Healing currently does not accept Medicaid.​

Free and Reduced Fee Therapy Application

Please complete this form to determine your eligibility for free or sliding scale fee therapy services by one of our Mental Health Partners paid for by Everyone's Healing. Please note that you may be asked to provide proof of income after submitting the application. 


Everyone's Healing strives to provide inclusive LGBTQ+ affirming, anti-ableist, and anti-racist providers. Everyone's Healing does not inquire about immigration status. 

Birthday
Month
Day
Year
Would you like to attend sessions virtually or in person? Select all that apply.
I frequently stress about meeting basic needs & don’t always achieve them.
Yes
No
I have access to health care.
Yes
No
I have health insurance but my deductible is too high to afford mental health services.
I earn the following amount per year:
$22,000-30,000
$31,000-41,000
$42,000-50,000
$51,000-60,000
Other
I can afford to pay the selected amount below per session. For a total of 14 sessions. Select all that apply.
Type of therapy. Select all that apply.
I am available to attend sessions at the following times. (Please note we cannot guarantee your preferred timeslot but will do our best to accommodate your availability)

Therapy Services: Client Responsibilities and Agreement

Everyone’s Healing is committed to helping you access the therapy services you need. Please review the following information about your services and responsibilities:

  • Therapy sessions: Everyone’s Healing will provide funding for up to 14 therapy sessions with an outside therapist or therapy agency. Services are subject to therapist availability and scheduling.

  • Copayment: You are responsible for paying the copayment amount selected above, if applicable. Any required copayment should be paid as directed by the therapist or therapy provider.

  • Keeping appointments: Please make every effort to attend your scheduled appointments. If you need to cancel or reschedule, please contact your therapist as soon as possible.

  • Missed appointments: If you have three (3) no-call/no-show appointments, your therapy services may be suspended. A no-call/no-show means missing a scheduled appointment without providing reasonable notice to the therapist or therapy provider.

  • Responding to scheduling attempts: Please stay in contact with your therapist or therapy provider and respond to scheduling requests. If you do not respond to the therapist’s scheduling offers or attempts to schedule services for one (1) business week, your services may be suspended.

  • Returning to services: If your services are suspended, you may contact Everyone’s Healing to discuss whether services can be resumed. Resumption of services is subject to available funding, the 14-session limit, and therapist availability.

  • Responsibility for therapy: Your therapist or therapy provider is an independent provider responsible for your clinical care, treatment, and professional decisions. Everyone’s Healing provides financial assistance for eligible therapy services but does not direct or control your therapist’s clinical judgment.

By signing this form, I acknowledge that I have read and understand these expectations and agree to participate in services in accordance with the terms above. I understand that Everyone’s Healing is providing funding for up to 14 therapy sessions and that I am responsible for any copayment identified above.

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