Sign Your Child Up for Therapy | Hopebound Mental Health, Inc

We provide low or no-cost one-on-one confidential virtual therapy to young people in Georgia and New Jersey. Participants do not need insurance.

Need more information before signing up?

Learn more by clicking through the links below.

The Hopebound Experience

What is Therapy?

FAQs

Does My Child Need Therapy?

For further questions, please email hello@hopebound.com.

Therapy Sign Up Form

This is a secure form and your privacy is protected. This data will never be shared with a third party.

"*" indicates required fields

Your Name*

Your Child's Name*

Your Child's Date of Birth*

Where are you based? (City & State)*

City State / Province / Region

Your Email*

Your Phone Number*

Your Child's Email, if they have one:

Preferred Method of Contact?*

How did you hear about Hopebound?*

If you heard about Hopebound through your child's school, please list the name of their school here:

Tell us a bit about why you are interested in your child beginning therapy or why your child is requesting to begin therapy.*

Do you have any preferences for the identity of your child's therapist (gender, race, ethnicity, sexuality, religion)? We will do our best to accommodate your request.*

If sessions take place at home, is there a private area with stable Internet connection where your child can attend their sessions?*

Does your child have a history of self-harm, suicidal thoughts, or suicidal attempts?*

Does your child qualify for Free or Reduced Lunch?*

Hopebound offers its weekly individual therapy services on a sliding scale, from $0 to $30 per week. How much are you able to financially contribute to services at this time? Note there are approximately 30 sessions per academic year as counseling concludes in late April.*

Every dollar counts in the effort to bring therapy to all, but it is not the only way to support Hopebound and our services. Consider signing up to volunteer, giving an anonymous parent testimonial, or being a part of our crowdfunding campaign for Giving Tuesday.

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