Access to Doorways CLIENT SUBSIDY APPLICATION
Healing for Queer & Trans Folx, Black, Indigenous, and People of Color (QT/BIPOC) by QT/BIPOC providers
PSYCHEDELIC ASSISTED PSYCHOTHERAPY - For All of Us

While training in the field of Psychedelic Assisted Therapy, it became alarmingly clear that there was a huge racial gap and little representation from sexual and gender minorities. This is true for both clients accessing psychedelic medicines in a therapeutic setting and therapists providing these services. Led by a Queer Black woman, Access 2 Doorways is a 501(c)(3) nonprofit organization founded to expand access to treatment and training for BIPOC, Queer and gender diverse folx to heal in the (re)emerging psychedelic therapy field.

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As subsidies are available, applicants can expect 25%, 50%, 75% or 100% funding to cover the cost of psychedelic assisted therapy treatment. At this time Ketamine treatment is the only legal psychedelic in the United States and the only form of treatment we offer to subsidize. As more psychedelic medicines become legally available, we will expand our subsidy coverage. To qualify for a subsidy, one must self - identify as QT/BIPOC and your KAP provider must self-identify as QT/BIPOC as well.

Please note there are two portions to this application. You must complete this form and your provider must complete the "Qualifying Therapist Subsidy Application" here: https://forms.gle/Pc5c2FYJ8vU1wgcg7
ALL SUBSIDIES WILL BE OFFERED FIRST COME, FIRST SERVED FOR INDIVIDUALS WHO COMPLETE THE BELOW FORM AND VERIFY THE INFORMATION PROVIDED UPON BEING CONTACTED BY ACCESS 2 DOORWAY
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Name *
First and last name
Email *
Phone Number *
How did you hear about us? *
When attempting to reach out, can we leave: *
Required
We aim to center persons holding marginalized identities in this process including Trans/non-binary/two spirit and otherwise gender expansive folx, and queer folx. Please let us know of any of your identities we may consider: *
Required
We aim to center persons of color in this process. Please let us know of any of your identities we may consider: *
Required
Provider Information
In order to qualify for a client subsidy, your psychedelic provider must be offering legal psychedelic services. At this time ketamine assisted psychotherapy is the only legal psychedelic service offered in the United States.

In addition, these legal requirements our client subsidies are for Queer and/or BIPOC clients seeking psychedelic assisted therapy from Queer and/or BIPOC providers. Please complete the information for your provider below and share this link for the provider portion of your application https://forms.gle/Pc5c2FYJ8vU1wgcg7
Name *
Phone *
Email *
Website *
Previously verified clinics
if you have a provider from one of our previously verified clinics, please select the clinic below
Financial Information
Please provide information on your current financial circumstances. We understand that every individual has a unique financial story and we want to factor in all elements of your story in making considerations for the most appropriate subsidy level.
Annual Income *
Dependents *
Please list any individuals you support financially (i.e. children, parents, extended family)
Access to Wealth *
Please include any support from family, partners, friends, inheritances, etc.
Percentage of Subsidy Desired *
Statement of Need *
Please tell us why you are looking for a subsidy at this time. You may include personal circumstances and marginalized identities not mentioned above (i.e. disabled and chronically ill folx, immigrants, fat folx, religiously persecuted folx, single parents, and seniors)
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