Sign Your Child Up for Therapy

Thank you for considering Hopebound to serve your child’s mental health needs.

We work with middle- and high-schoolers to provide free one-on-one confidential virtual therapy to young people in Georgia and New Jersey. Participants do not need insurance and there is no cost to families.

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.

Your Name(Required)

First Last

Your Child's Name(Required)

First Last

Your Child's Date of Birth(Required)

Where are you based? (City & State) *(Required)

City State / Province / Region

Your Email(Required)

Your Phone Number(Required)

Your Child's Email, if they have one:

Preferred Method of Contact?(Required)

How did you hear about Hopebound?(Required)

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.(Required)

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.(Required)

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

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

Does your child qualify for Free or Reduced Lunch?(Required)

Art by Morgan Harper Nichols

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We can work together toward a world of greater hope for our adolescents.

Sign Your Child Up for Therapy

Thank you for considering Hopebound to serve your child’s mental health needs.

Need more information before signing up?

Therapy Sign Up Form

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