Sliding Scale Fees

To help us keep our programs accessible and direct support to those who need it most, we may request a copy of your most recent Notice of Assessment to verify eligibility. Thank you so much for your understanding and partnership in keeping this resource sustainable.

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Name *

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Do you consent for us to contact you by e-mail or phone call? *

What is your primary source of income? *

What is your total annual household income before taxes? (Please include all sources, such as employment, a spouse/partner's income, pensions, or investments.) *

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If you selected employment, please indicate your family size. *

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I understand and agree to the terms.

In checking the box above, I agree and confirm that all the information provided is true and accurate. I acknowledge that bookmytherapy's team will reach out to me.
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Sliding Scale Fees

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