In-person therapy through Seed Peace with National Farmer Mental Health Alliance

Thank you for taking the time to invest in yourself on your wellness journey. Seed Peace has a strong and collaborative relationship with the National Farmer Mental Health Alliance (NFMHA). This form is designed to help ensure you are matched with a counsellor who can best meet your needs. Every member of the NFMHA team has completed specialized training and earned the designation of Agriculture Informed Therapist (AIT), equipping them to provide culturally informed, agriculture-specific care. All information you provide will remain confidential and will only be used to connect you with the most appropriate counsellor.

By submitting this form, you are giving Seed Peace permission to share your information with the NFMHA. A trusted therapist from their team will reach out to you as soon as possible. If at any time you feel unsafe or unable to keep yourself safe while waiting, please go to your nearest hospital or call 911 right away. You are not alone, and support is available.  Upon completion you will be contacted by someone from NFMHA and matched with a therapist within 48 hours.  Seed Peace will provide up to 6 sessions with a therapist at no charge to the farmer.  
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Email *
Agriculture Informed Therapy™ (AIT) Therapist are trained to the unique needs and treatment strategies for farmers, their families, and their communities.  All therapist with NFMHA have been trained in AIT.  
Do you consent to your name and information below to be shared with National Farmer Mental Health Alliance in order to match you with a therapist?  All of your answers will be kept confidential and will not be used for advertisements or sold for any reason.  If you do not consent, you will not be matched with a therapist.  *
Full Name *
Phone number including area code (xxx) xxx-xxxx
What County in Colorado do you reside?  *
Are you a sustainable farmer? *
Please list your farm website or social media link. *
Do you have a preferred gender for your therapist? *
Required
Do you have any particular counseling areas you would like to use for matching? 
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