HS Reduced Fee & Grant Eligibility Request Form

The purpose of this program is to make our psychological services accessible to individuals who financially need them, specifically those who are uninsured, underinsured, or facing financial hardship. 

Your request for reduced fee services is on the basis of an “honor system” relationship between you and Healing Spaces. It is expected that you notify us if your ability to pay more has changed. As you can make incremental increases in the number of your payments, other clients who also have specific financial circumstances may then be able to benefit from the reduced fee position you have made available

While we will do our best to accommodate all, specific requests for reduced fee services will be evaluated based on client needs and the percentage of reduced fee positions that are available at the time of the request. 

Regardless of your financial circumstances, you are entitled to the full benefits of services. Healing Spaces maintains a commitment to support equitable treatment and we encourage you to talk to us directly or email us at info@healingspacesstl.com if our practice seems to be out of alignment with our commitment. 

To request services, please complete the following questionnaire. Please note that questions asked about demographic information are to ensure that we are equitably serving clients from marginalized and diverse backgrounds. Please note that reduced fees are reassessed every 90 days.

In some cases, we may also have grant funding available for youth aged 10-22 sponsored by the St. Louis Mental Health Board, particularly those who identify as LGBTQIA+ or are youth of color. If eligible, this funding would fully cover the cost of services. 

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Email *
What is your name? *
What's a good number to reach you? *
What is the Client's full name? *
Which program are you interested in? *
Required
Are these services for an adult or minor? *
Do you have Medicaid?  *
Required
If you have Medicaid, provide your Medicaid ID number and date of birth below to check eligibility. 
If the services are for a minor, is there anyone else who has custody of the child?
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Is the client a part of a minoritized community? *
If yes, please indicate (e.g., BIPOC, LGBTQ+).

Is the client currently experiencing, or have they previously experienced, significant emotional or mental health challenges that impact their daily functioning?

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What is your household income? *
How many dependents live in the home? *
What services are you seeking? *
Required
How Reduced Fee Requests Are Reviewed

We understand that financial circumstances can change, and we review reduced fee requests with care and thoughtfulness. Decisions are based on current availability, clinician capacity, and scheduling needs.

At this time, the amounts listed reflect the lowest fees we are generally able to offer, though availability may change as Access Fund support, clinician capacity, and scheduling shift.

Reduced fees are re-evaluated every 90 days to ensure we can continue providing high-quality, sustainable care. While reduced rates are not guaranteed and may change over time, we are committed to being transparent and will always do our best to explore options when possible.

Our standard rate for a 55-minute individual therapy session are from $175.

If you are requesting a reduced fee, please select one of the options below that best reflects what you are currently able to pay:

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Our standard rate for a 75-minute couples therapy session is $245.

If you are requesting a reduced fee, please select one of the options below that best reflects what you are currently able to pay:

 *
How frequently would you be able to attend therapy sessions? *

Our standard comprehensive evaluation fee is $3200 typically divided into three payments.

If you are requesting a reduced fee, please select one of the options below that best reflects what you are currently able to pay at this time:

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Please choose at least three preferred clinicians for therapy. Your selections help us plan and match you with a therapist, though final scheduling will depend on clinician availability.

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Required
In what state are you located? *
Why are you seeking services? *
Do you have Medicaid? *
If so, what plan? We may be able to match you with a provider that accepts Home State Health or Mo Health Net (Straight).
Is there anything else that is important for us to know? *
How did you hear about this program? *

Thank you for submitting your information. The office will be in contact with you within 3-5 business days to confirm we received your request for services. If at any time you would like to check on the status on the list, please email us at info@healingspacesstl.com. 

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