Request form
First things first, if you or someone you know is experiencing a mental health emergency or in IMMEDIATE danger, please call your local emergency number (e.g. 911 in the U.S.) Click here to find your country’s helpline numbers if needed.
Please note: Our Therapy Funding Form opens once a quarter. Once you have signed up you will receive a submission email as well as a follow-up email from one of our team members. If the form is closed when you visit, no worries! Add your email in the form below and we will let you know as soon as it reopens!