Let’s work together Name * First Name Last Name Email * Phone (###) ### #### Are you able to make it in-person to all 8 weeks of the group? (Mondays, 7-8:30pm - Oct. 27-Dec 15) Yes, can't wait! I think so. I might miss one. We believe everyone deserves access to effective, high-quality mental health care, regardless of financial circumstances. To support this, we offer a limited number of sliding scale options in our groups and for clients experiencing financial hardship. The framework below is adapted from Alexis J. Cunningfolk’s Financial Justice model*, is intended to help you identify where you best fit within our sliding scale structure. * Full Cost This rate reflects the full value of the service and supports the sustainability of our practice. It’s intended for individuals with financial stability who can comfortably meet their needs, afford non-essentials, and hold economic privilege through savings, property, or other resources. Shared Cost This rate acknowledges those with steady income who may still carry debt or live paycheck to paycheck but can generally meet basic needs. It offers a balanced option for those who can contribute without significant strain, helping make services more accessible to others. Supported Cost This rate is reserved for individuals whose financial circumstances would otherwise limit access to care. It’s for those prioritizing essentials like housing, food, childcare, or healthcare, and for whom higher tiers would present a hardship. Your participation at this level is valued equally within our community. If the lowest tier is still out of reach, we’re happy to discuss payment plans or flexible options. Full Cost $75/session Shared Cost $65/session Supported Cost $55/session When is your birthday? 🎂 MM DD YYYY How did you hear about this group? * Referral Psychology Today Friend Other Anything else you'd like me to know? Website http:// Thank you!
