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Sliding Scale Application

I offer sliding scale for the following clients with financial hardship:  BIPOC, single parents, survivors of abuse, public school teachers, and social workers.  

Name *
She/Her/Hers, He/His/His, They/Them/Theirs...
Cell Phone *
Cell Phone
Please list physical, emotional and spiritual matters you want us to work on.
My sliding scale is $50 - 125/hr. Please be mindful of your own ability to pay, and how you may be able to subsidize the cost for another.
Please check all that apply to you *