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