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Therapy Program 
A nine-week program offered by a licensed therapist meeting once a week for a 60-minute session. After the program, recipients will be offered admission into our Telehealth support group.

All information entered below will be kept confidential. By filling out the form below, I allow Beyond Grey to contact me and enquire this information. 

Please note a 7 day call back time, M-F.

Please note that we do not maintain 24-hour access to these forms. 
If you need immediate assistance, please go to your local emergency room or call 911. 

Other helpful resources may include:
National Suicide Help Line: 988
Crisis Text Line: Text START to 741-741
Email *
What is your first and last name?  *
What is your email address? 
*Please look out for an application response from info@beyondgreyinc.org
 *
What is your phone number?  *
Are you currently enrolled in a South Florida College?  *
If yes, what college do you currently attend? *
What days of the week are you available?  *
Required
What time works best for you?  *
Required
Do you currently have health insurance coverage?  *
If yes, what insurance do you have?
Were you referred to us by a counseling center? If no, skip the following question.  *
If yes, which center referred you to us? 
If no, how did you hear about us?  *
Are you currently seeing, or planning on seeing other therapist outside of this program?  *
Do you have access to a computer and internet connection? (Wifi) *
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