Queen Beauty Podcast Cares! Application

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Queen Beauty Podcast Cares is accepting donations if you or a loved one needs financial access to mental health counseling services for the following types of therapy: Individual, family, couples, postpartum and more.

After airing podcast episodes about self care and the importance of mental health services, we understand there are limitations with access to professional counseling services. Queen Beauty Podcast started an initiative to rally around and support those in need of counseling services. 10% of all merch proceeds will go toward Queen Beauty Podcast Cares.

If selected, we will use donations to pay for your counseling services for up to 2 sessions at a max value of $200 or $100/session.

The donation link if you wish to support our mission to promote access to mental health & wellness today.
https://paypal.me/pools/campaign/115804339917805200

Name (First & Last)

Email Address

Phone Number

Type of Counseling Service Requested

Individual

Family

Marital/Couples

Pre or Post Natal

Children (If your child is under 18 years old)

Clear selection

Who are you seeking mental health counseling services for? *

Yourself

Loved one

If you selected "loved one", please provide their name and contact number (Skip if for yourself)

If you have insurance, have you contacted your insurance to seek mental health services and/or EAP (employee assistance program)? Optional

Yes

I did not know I could contact my insurance

Clear selection

How would you or loved one like to be notified if selected as a recipient for services.

Phone

Text

No preference

Clear selection

Is there anything you would like to add?

I understand that If selected as a recipient for counseling services, Queen Beauty Podcast will pay your counseling services directly to the mental health provider for up to 2 sessions at a max value of $200 or $100/session.

Yes, I understand

I understand that my name and contact information on this application submission will be kept confidential. Queen Beauty Podcast will not share your identity unless granted expressed written consent by the person completing this application.

Yes, I understand

I understand that if granted a recipient, my name and contact information will be kept confidential. Queen Beauty Podcast will not share your identity unless granted expressed written consent by the person receiving services.

Option 1

Clear selection

I acknowledge that I am the true identity of the person completing this application and have not falsely provided any of the above information.

Option 1

Submit

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