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.

Please complete the questions below. You will receive a response within 4-5 business days.

Please note: we often have a waitlist for lower fees but we do our best to reduce your fee as much as we can as soon as we can.

We also highly recommend Redefine Life which is a low cost counselling centre in Boronia that also offers phone/online sessions at $45/hour. If you'd like us to refer you to the provisional or volunteer counsellors at this centre let us know below. https://www.redefinelife.com.au/

Email *

What’s your name(s)? *

What’s your phone number? *

Are you seeking individual or relationship support? *

Individual

Relationship

Would a payment plan be supportive to you (this is where the full fee paid in smaller amounts over a longer period of time)? *

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? *

$10-$20 off the full fee

$25-$35 off the full fee

$40 - $50 off the full fee

$50 - $60 off the full fee

$60 - $80 off the full fee

Other:

If your preferred fee reduction (that you selected above) isn't available, do you want to join a waiting list? (this could be anywhere from 3-6 months) *

Yes

Not sure

If your preferred fee reduction isn't available, would you like to begin sessions at a higher sliding scale place?

Yes

Not sure

Clear selection

If we're not already working together, what makes you interested in working 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

Mentally ill / mad

Aboriginal people

Homeless 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

Those with a chronic illness

Unemployed folks

Fat folks, people with larger bodies

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.

If you take a break or discontinue your sessions without letting us know we'll give you sliding scale place to someone else on the waiting list.

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.

Submit

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