Please fill in the form below
We understand that seeking help for mental health can be a challenging step, and we are here to support you every step of the way. The information you provide in this form is essential for us to understand your situation and the reasons you need our financial assistance. This allows us to assess your needs accurately and connect you with a suitable therapist if you do not already have one in mind. Rest assured that all information shared with us is kept confidential and used solely for the purpose of providing you with the best possible support. If you are applying for someone else on their behalf please fill out their information.
