Community Care Fund
If you live in Mecklenburg County, are pregnant or within two years of your baby's birth, and are unable to access needed mental health support due to cost, transportation or child care issues, please fill out the form below.
* Required
Email address
*
Your email
Name
*
Your answer
Full Address
*
Your answer
Best Contact Phone Number
*
Your answer
Email
*
Your answer
Child's Birth or Due Date
*
MM
/
DD
/
YYYY
YOUR Birth Year
*
Your answer
Do you have insurance?
*
Yes
No
Other:
If yes, what is your copay amount for therapy?
Your answer
Please detail company or source & type of health coverage. (N/A if none)
*
Your answer
Do you have a therapist you wish to work with?
Your answer
Do you have transportation access or virtual access to needed services?
*
Yes
No
Other:
Please detail if answer is No or Other.
Your answer
Please share any other information you feel is important that we understand.
Your answer
Our support staff will reach out to you very soon to see if we can assist you in getting the care you deserve.
Send me a copy of my responses.
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