Low Cost Therapy Application - Front Range Family Resource Center

FRFRC Low Cost Therapy Application

Application for our Low-Cost Therapy program. Please fill it out, and our support team will contact you shortly.

Front Range Family Resource Center Low Cost Therapy Application!

Please use this application to provide details that will help our selection committee determine your needs and whether or not you qualify for low-cost therapy. Not everyone will qualify, but if you do, we will reach out when our application begins in September and January. Be as thorough as you can. Please note “I do not have money” will not pre-qualify you for our program.

About You

Please proved the below relevant information for our selection committee to help determine your need.

Your Name(Required)

First Last

How Can We Reach You?

We would love to chat with you. How can we get in touch?

Preferred Method of Contact(Required)

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Please provide a valid phone number so we can contact you when selected!

Best Time to Call You(Required)

What brings you to therapy at this time?

Please describe in detail what you are looking to achieve in therapy.

Please use the space below to tell us what you would like to work on in therapy and whether or not you have used therapy services prior(Required)

Please take some time to help us determine your needs and whether or not you are a good fit for our student therapist.

How will you benefit from Low-Cost Therapy? Is there a current financial hardship preventing you from paying our full rate?(Required)

Counseling Type(Required)

Individual

Couples

Student Therapy Services

Please let us know if you are seeking individual or couples counseling.

Counseling Services(Required)

In-Person

Tele-Health

Are you looking to come into the office or use tele-health?

Do you understand our student, pre-licensed, and fully licensed policy?(Required)

Yes

Please view our low-cost therapy page here: https://frontrangefrc.com/low-cost-therapy-in-wheat-ridge-colorado/

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