Application for Free Therapy Service
*IMPORTANT UPDATE* - We have started a waitlist for services as the number of applicants continue to grow. By completing this application, your name will go on a waitlist and you will be contacted if and when funding is received and services have been identified in your area. Please note services are NOT GUARANTEED when completing this application.

_________________________

BFT has partnered with some licensed therapists across the country, that would like to service those in need at this time. These therapists have agreed to lower their fees or to offer services pro bono. You will be offered 2-3 sessions at the cost of $0 to you. Currently, BFT is raising fund to cover all cost for your services. If more sessions are needed, you can discuss this with your therapist.

Once we locate a therapist in your area, you will receive notification from BFT confirming connection and will receive further correspondence from the therapist.

*Please Note: Completing this form does NOT GUARANTEE you get connected with a therapist. BFT does NOT have therapists in all 50 states. BFT is not equipped to assist with emergencies and cannot match you with a therapist if you are actively suicidal. If you are feeling suicidal please contact 911 or The National Suicide Hotline: 1-800-273-8255.
Name *
Email *
Phone number *
State you currently reside in *
Briefly explain your concern at this time. *
By checking this box, I certify that I am not presently feeling suicidal. If I am, I will call 911 or the Crisis Hotline listed above. I acknowledge that Black Female Therapist is not crisis counseling and that online therapy is not suitable for anyone who is actively suicidal. *
Required
Thank you for completing this form. We will contact you soon with your connected therapist.
Submit
Never submit passwords through Google Forms.
This form was created inside of Black Female Therapists. Report Abuse