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Consultation

MIND AND WELLNESS FOUNDATION
TREATMENT GRANT QUESTIONNAIRE

General Grant Overview 
 
The Mind and Wellness Foundation will reimburse up to $100.00 per session for an individual session (60 minutes). Monthly billing per individual may not exceed $400.00. It will be up to the service provider to determine if this satisfies the patient’s bill in full, or if a co-pay amount is required. Recipients are responsible for any additional charges incurred on their account.
 
It is the recipient’s responsibility to inquire about what sliding scale/ discounted rates are available before seeking a grant with the Mind and Wellness Foundation.

General Grant Guidelines 
 

  • Mind and Wellness Foundation offers financial assistance on a first-come, first-served basis for individuals that demonstrate financial barriers or limitations to accessing mental health care and are either uninsured or underinsured for behavioral health care and approved by the foundation. 

 

  • Mind and Wellness Foundation does not provide direct treatment services and we cannot accept responsibility for any of the services provided by those found via partner portals or any other providers the recipients select. 

 

  • We require that services be provided by, or under the supervision of, a licensed mental health care provider.

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Mind and Wellness Foundation (MAWF)
Therapy Grant Questionnaire 

Gender
Gender
What therapist directory do you think you will use to find a therapist?
Is this your first time signing up for a MAWF Therapy Grant?

(Do not fill out this form if you have received a grant in the past) *

Additional Terms & Conditions

No Provision of Healthcare or Medical Advice

You understand and agree that the  Mind and Wellness Foundation does not make any recommendations regarding the selection of an appropriate therapist and does not provide any medical care or advice.

 

You are solely responsible for decisions regarding your own healthcare. Therapist directories and other content made available on our website or on the Portal is provided for informational purposes only, and Mind and Wellness Foundation does not endorse any particular provider or course of care.

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 In selecting and working with a Provider, we encourage you to conduct your own research and interviews to identify the individual or organization that is right for you. 

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Release of Liability and Waiver of Claims; Disclaimer of Liability

By agreeing to these Terms and Conditions and in consideration of your participation in the Program, you agree to waive and release Mind and Wellness Foundation and its directors, officers, employees, volunteers and agents from any and all liability, claims, costs and damages of any kind which you, your next of kin, or your legal representatives may have or which may later accrue, resulting or arising directly or indirectly from your participation in the Program.

 Further, Mind and Wellness Foundation expressly disclaims any and all liability for any claims arising out of a participant’s relationship with their Provider, including but not limited to any act, omission, response, advice, suggestion, information and/or service of any Provider.

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Survival

These Terms and Conditions will apply for as long as you are a participant in the Program and will continue to apply with respect to your participation in the Program after it has concluded.

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Upon your acceptance of these Terms and Conditions, Mind and Wellness Foundation  (hereinafter, “we,” “us” or “our”) will grant you (hereinafter, “you” or “the Participant”) access to the Mind and Wellness  Therapy Grant Portal (the “Portal”) and make available to you, through the Portal, certain grants that you may use toward qualifying therapy services, in accordance with the instructions set forth in Mind and Wellness Foundation Participant Overview Document (the “Participant Overview Document”) In the event of any conflict with the Participant Overview, these Terms and Conditions shall govern.

 

Please note this is a legal document and, by accepting these Terms and Conditions, you are entering into a legally binding and enforceable agreement. 

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