• info@cogntivetherapy.com

    Sliding Scale Form


    ​Do you have out-of-network benefits for mental health?
    ​Are you available during weekday daytime hours (10am-4pm)?
    ​Annual Income (please include all sources of income, including family contributions). You may be asked to verify this income with a pay stub or financial statement
    ​Reasons why you are unable to pay the full fee. Please provide any details that may help us understand your need for a lower fee, such as loss of income, medical expenses, significant debt, etc
    ​Please list the maximum session fee you are able to pay:
    Have you been referred by a therapist on our team to complete this form?
​Sliding Scale FAQ
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Who is eligible for the sliding scale?
NYCCT offers a sliding scale fee for those who cannot afford the full fee. The sliding scale is designed to help those who do not have out of network coverage or have high insurance deductibles. The scale is based on availability and financial need.

How do I know if I'm eligible?
In order to be eligible for the sliding scale, you must apply and provide income information and an explanation of why you cannot pay the full fee. Although in most cases sliding scale is offered on an honor system, we may occasionally ask for you to verify your income (with a paystub or financial statement).

How long can I receive a sliding scale rate?
Sliding scale rates are approved for a duration of 6 months at a time. If at any point during that time your income situation changes, please communicate this to your therapist. After your rate expires, you will default back to the full fee unless you re-apply for sliding scale and are approved. Generally, there is a limit to how many times a sliding scale will be approved and you can expect to eventually default to the full fee. For this reason, we ask that you consider sliding scale a benefit that is intended to help you bridge a time of financial hardship, rather than a permanent change in your fee.

​What time slots are eligible?
Time slots are based on therapists availability. We see clients weekday morning, afternoon, and evenings, and also have some availability on Saturdays and Sundays.

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