Sliding Scale Request Application

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A sliding scale is a negotiated fee or reduced session fee based on someone's access needs. This is often to reduce financial barriers to support. Several sliding scale places are available and the negotiated fee is based on a range of factors including the amount you can actually afford to pay and how many other people I'm currently working with that are accessing a sliding scale.

Visit Inner Melbourne Clinical Psychology's referral list for low-cost or free mental health counselling/support services in Melbourne https://www.innermelbpsychology.com.au/low-cost-counselling-melbourne/

Please complete the questions below. You will receive a response within two business days.

Please note: we currently have a 3-5 month waitlist before more places become available.

Email *

What’s your name(s)? *

What’s your phone number? *

Are you seeking individual or relationship support? *

Individual

Relationship

Would you like access to a payment plan (full fee paid in smaller amounts over 30 days)? *

Yes

Would you like access to a sliding scale (fee reduction)? *

Yes

If you answered yes to a sliding scale: What fee or fee range feels more affordable? *

If no current placements are available, would you like to join a waiting list? *

Yes

What makes you want to work with me? *

Reduced barriers

People who are parts of communities that are more likely to experience ongoing oppression are prioritised for reduced fee sessions as they're more likely to face more exclusion that might limit their access to pleasure-positive, trauma-informed sexual and wellbeing support. Offering reduced fees to folks with thees identities can assist in removing barriers to support services.

Are you part of any of the following communities?

Disabled people

Neurodivergent (identities that tend to be named "mental illnesses"

Aboriginal people

Torres Strait Islander peoples

First Nation or Indigenous person

Transgender folks

Non-binary or gender non-conforming

Black folks

Brown folks or people of colour

Chronic illness

Fat folks, people with larger bodies

Unemployed

Homeless

LGBQIA+

Other:

Sliding scale terms & conditions

* In requesting & accepting this ongoing sliding scale, I ask that you please communicate if/when you'd like to take a break from sessions or if you no longer wish to continue working with me via email/text so I can make your sliding scale available to others.

** Please note the request for ongoing, transparent communication will support me to make this sliding scale more accessible to those who need it on an ongoing basis as places are limited.

Is all the information stated on this form accurate and do you agree to these terms & conditions? *

Yes

Other:

Send me a copy of my responses.

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