Sista Afya Community Mental Wellness: Therapy Request Form

Thank you for your interest in receiving therapeutic services at Sista Afya Community Mental Wellness. Please take 5 min. to fill out this form. We will contact you as openings become available via e-mail to schedule a phone consultation. If we do not believe it would be a fit for us to be your mental wellness provider based on the information you provide in this form, we will send you a list of referrals to other providers via email.

ATTN: We do not provide individual therapy for children, teens or families. If you are looking for a children or family therapist, please review our Preferred Providers List at:

If you have any questions, feel free to reach out us at: . NO PHONE CALLS PLEASE!
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