Request edit access
Accessible Care Options Request Form
This form is for clients who may need temporary support accessing therapy. Our mission is to make therapy more accessible for the South Asian community, and this option helps support that.

All information you share is confidential.
Choosing an Accessible Care Option does not change the quality of your care — your therapist, your care plan, and the support you receive all remain the same.

Email *
Full Name *
Email Address *
Phone Number *
What type of therapy are you seeking? *

Do you have any health insurance that may cover the cost of mental health therapy?

(Most work and student plans include therapy coverage.) 

 *
Briefly tell us why you are requesting an Accessible Care Option. *
What session fee range would make therapy accessible for you? *

How long do you anticipate needing this accommodation?

 *
Do you have a preferred practitioner you would like to work with?
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