REQUEST FOR FINANCIAL ASSISTANCE

Thank you for applying for therapy cost assistance through The Mental Health Society! Please review the following information carefully before proceeding with your application.

EMERGENCY NOTICE

If you or someone you know is experiencing a mental health crisis, please call 911 or go to the nearest emergency room immediately.

ELIGIBILITY

This program is available to Houston students who need financial support for therapy outside of school. The Mental Health Society provides funding for up to 12 sessions, which can be used at your own pace.

SESSION ATTENDANCE POLICY

If you or your child miss a session without providing at least 48 hours' notice to the therapist, The Mental Health Society will not cover the cost of that session. You will be responsible for the full fee in cases of no-show or late cancellation.

CONFIDENTIALITY

Your privacy is a priority. All information shared during therapy remains confidential unless there is a risk of harm to yourself or others, or you provide permission to share information.

I acknowledge the information above and agree to cover the full cost of any session if I fail to attend or cancel without sufficient notice.

Student First and Last Name

Grade Level & Campus

Student Cell Phone Number

If you are under 18, please provide your parent’s name and phone number.

Please describe your circumstances that create the need for financial assistance with counseling. For example, explain your financial situation and whether your parents or guardians support your decision to seek therapy and assistance. All information is confidential.

How soon would you like to begin counseling?

Are you and/or your parents willing to sign a Release of Information with our partner pratice allowing us to handle payments on your behalf? Note: This release is solely for payment purposes, and no other information will be discussed with your therapist.

Thanks for your submission! Our team will reach out to you to discuss scheduling your first appointment.

REAL VOICES FROM OUR COMMUNITY

Before TMHS, I didn’t think therapy was even an option for me. I was falling behind in school and couldn’t get out of my own head. Now I have a therapist who gets me — and I finally feel like myself again.

SPRING BRANCH ISD JUNIOR

When my daughter started therapy through TMHS, I could see the weight lifting off her shoulders. As a parent, knowing she’s supported and healing is the best gift imaginable.

PARENT OF TMHS STUDENT

When I started therapy through TMHS in high school, I was struggling to keep up — emotionally and academically. Having someone to talk to changed everything. I learned how to manage my anxiety, set boundaries, and take care of myself. Now, as a college sophomore, I still use what I learned in therapy every single day.

FORMER TMHS STUDENT,
NOW COLLEGE SOPHOMORE

REQUEST FOR FINANCIAL ASSISTANCE

REAL VOICES FROM OUR COMMUNITY

SPRING BRANCH ISD JUNIOR

PARENT OF TMHS STUDENT

FORMER TMHS STUDENT, NOW COLLEGE SOPHOMORE

FORMER TMHS STUDENT,
NOW COLLEGE SOPHOMORE