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. 

In some cases, we may also have grant funding available for youth up to age 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.

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.

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Email *
Which program are you interested in? *
What is the Client's full name? *
What's a good number to reach you? *
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?
Clear selection
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?

 *
What is your household income? *
How many dependents live in the home? *
What services are you seeking? *
Required

For reduced fee requests: Our standard rate for a 45-minute therapy session ranges from $165 to $250. What fee are you currently available to pay? At this time, the lowest fee we’re able to offer falls between $100 and $120, depending on the clinician. 

We understand that this may still be out of reach for some, and if this rate doesn’t work for you, please email us at info@healingspacesstl.com to receive additional referrals. 

If you are not seeking therapy, put N/A.

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

For reduced fee requests: Our standard evaluation fee is $2,995, typically split into three payments.What fee are you available to pay? At this time, the lowest fee we’re generally able to accept ranges from $1,800 to $2,000. 

We may be able to offer some flexibility depending on the availability of our doctoral interns, and we’ll always do our best to accommodate your needs.

Please let us know what fee you’re currently able to pay so we can explore possible options.

Please choose at least 3 preferred clinicians (for therapy). *
Required
In what state are you located? *
Why are you seeking services? *
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 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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