Payment & Fees

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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

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 

Insurance

/Self-pay

We accept Blue Cross Blue Shield PPO for Insurance for therapy and self-pay at $120 at session.

Fill out the form below to get started.

Sliding Scale

We provide a sliding scale rate for $75 a session for people making less than $3500 a month. Space is limited. 

Fill out the form below to get started.

Teens

We provide therapy to teen girls ages

13 -18. 

Please fill out this form if you are a parent/guardian of a teen.

Click here to view our Teen Therapy Procedures

EAP

We provide short-term therapy to workplaces offering EAP through LifeWorks, Optum EAP, Cigna EAP and Lyra Health.