Program

Mental Health Financial Assistance Fund

We know that cost can be a significant barrier to accessing mental health care. That’s why we created our Mental Health Financial Assistance Fund to help individuals and families who need financial support for mental health or wellness services. Eligibility is based on financial need, ensuring that care is accessible to those who need it most.

You may be eligible for financial assistance if you:

Have limited or no health insurance

Can show you have a financial need

Have medical bills in an amount that exceeds your ability to pay

Have already selected a provider and know the amount of the session fee

Possess a strong desire to get back to the healthiest version of yourself

If you are eligible for financial assistance, please fill out this form to receive financial assistance. Please know that financial assistance is based on availability.

Name(Required)

First Last

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

(xxx) xxx-xxx

Please select the one that applies(Required)

Single

Married

Divorced

Widowed

Employer's Name(Required)

Spouse's Employer's Name

If married...

Monthly Household Income(Required)

Amount of Monthly Household Bills(Required)

Mental Health Provider(Required)

Include name of provider, name of office, phone number and session fee

Explain your need for financial assistance(Required)

Be as detailed as possible

Type Your Full Name(Required)

By typing your full name in the box above, you are confirming that the information you have provided is accurate.