Sliding-Scale Counseling Request Form
Haga clic aquí para Español. / Click here for the form in Spanish.
This form is for individuals, couples, families, and other intimate relationships looking to be matched with one of our trainees for sliding scale counseling. All members join on a monthly membership, which includes weekly psychotherapy sessions and access to our groups. Our membership fees are based on your overall financial situation — the monthly rate ranges from $120 to $550, determined on a sliding scale according to each person's individual circumstances.
If you have any questions, please call us: (323) 935-1807
Taking the first step towards building more support in your life takes courage. We’re honored to be one of the resources you are reaching for.
As you fill out this form, the more information you are comfortable providing, the better. The information you submit here will not be shared with anyone outside of The Relational Center.
If you are more comfortable speaking with someone over the phone to submit your request, we welcome your call.
If you have already submitted a request, you are welcome to contact us for an update on your waiting list status.
Counseling Request Form