Required: Get started with therapy by filling out the appropriate therapy request form and

 scheduling a 15 min. phone intake below. If you do not complete both of these steps, this will delay you from getting started with therapy:

 

15 min. phone intake link: https://calendly.com/sistaafyatherapy

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If you're interested in receiving free therapy visit Sista Afya Community Care's website:

https://www.communitycare.sistaafya.com/get-support

Do not use a mobile device to complete this form, please use a desktop or laptop to ensure
that we receive a completed form. You will receive a 'Thank You Message' on your screen to indicate that you completed the form.
Have a picture of your ID, insurance card, and proof of income (sliding scale only) ready before filling out a therapy request form.

 

Therapy Request Forms