Low Fee DBT Application

We are offering a new format for DBT that offers 1 hour long groups rather than 2 hr groups and is available at a lower fee of $45/session. This group is available to people who are experiencing financial hardship.

The group meets on Tuesday or Thursday evenings from 6:30-7:30pm over telehealth. You must commit to a full module. The three modules that comprise the program are below:

Distress Tolerance: 8 weeks
Interpersonal Effectiveness: 8 weeks
Emotion Regulation: 10 weeks

Please complete the following questions in order to be considered for this program.

First Name *

Last Name *

Phone *

Email *

How did you learn about DBT? *

How did you learn about our clinic? *

What problems or struggles are you hoping to work through with DBT? *

Are you currently seeing a therapist regularly? *

Yes

What is your annual Household Income? *

Are there other people you are financially supporting? Please describe. *

What other sources of financial support do you have? *

Do you have out of network insurance benefits? Please describe. *

Are there any extenuating circumstances we should consider? Please describe.

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