Cactus Rose Financial Aid Application

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If you are unable to afford or otherwise fund your therapy sessions, you may apply for a sliding scale or pro-bono appointment.

First and Last Name *

Phone number *

Email *

To better serve those who would not otherwise have access to treatment, I reserve these financial aid spots for those who do not have access to therapy through insurance and are unable to afford out-of-pocket pay. I ask that you don't apply for financial aid if you have insurance that I don't accept, but are able to receive treatment elsewhere- thank you for your understanding. If you are in need of a therapist who is covered by your insurance, you can search using an insurance filter here.

Please verify your status below.

I do not have insurance and the out-of-pocket fee is too high

I have insurance but my insurance does not cover mental health visits

I have insurance that covers mental health visits but it is still unaffordable for me

Other:

Required

Have you verified that I do not take your insurance? Verify here *

Yes

I don't have insurance

What are you hoping to work on in therapy?

Tell me a little bit more about your situation, and why you are applying for financial aid.

Are you able/willing to join a waitlist if there is not a spot currently open? *

I reserve one sliding scale spot, and one pro bono spot on my schedule. How much would you feasibly be able to contribute per session?

100

110

I cannot afford any contribution at this time, I'd like to explore pro bono as an option

Other:

I offer a pro-bono spot on my schedule as my way of contributing to my community and an attempt to make this world just a little bit better :) If you are applying for a pro-bono spot, do you have a skillset, ability, free time, or something else you would be willing/able to contribute to your community, neighborhood, or environment as 'payment' for your sessions?

Anything else you'd like me to know?

Submit

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