Are you a full-time employee of a local not for profit church or organization? We are grateful for your service to our community!

We offer six (6) pro bono counseling sessions to full-time (40 or more working weekly hours documented no less than 6 months) non-profit employees living in the Brazos Valley. Please complete the form below to get your session scheduled with one of our licensed providers. *We will require proof of income to complete approval process. We accept your most recent tax return or 6 months worth of pay stubs. Client will be responsible for paying session cost in full upon completion of six sessions.

Name

First Name

Last Name

Phone

(###)

###

####

What is the name of the non-profit you are employed with?

How long have you been employed with this organization?

Briefly describe your role, responsibilities with this organization.

With this form I acknowledge myself as a full-time NPO employee in Brazos County, working 40 or more hours each week. I give permission for the MWH administrator to confirm this with my employer.

YES

Have your previously received therapy? (If you are presently receiving mental health services you are not applicable for this service at this time).

How did you hear about The Made Well House?

Anything else you would like for us to know? Question?

Please note the best days and times you would be available to attend a counseling session during the week:

Are you a full-time employee of a local not for profit church or organization? We are grateful for your service to our community!

Location

Office Hours

Contact