Cold Springs Fire Voucher Application
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Client Name
Your answer
Address (at the time of the fire)
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Phone Number/Email
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Case Manager Name
Your answer
Are you seeking a voucher for use with a therapist that you currently see?
Will you be seeking someone new to work with?
How did you learn about the Voucher Program? (i.e. online, community meeting, support staff in Nederland, Mental Health Partners, etc.)
Your answer
We realize you all have been through a great deal, and that even discussion of impact can lead to very difficult emotional responses. The following is to help us better understand your need and what services may best support you in this process. Please give a brief description of your experience that has helped you identify your hope for support through the recovery process:
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