Neoma Wellness Subsidized Mental Health Program Application

Applying for Subsidized Counselling

We recognize the courage it takes to reach out for support. Our subsidized counselling program is designed to be accessible, respectful, and straightforward, so you can focus on your wellbeing.

How the Program Works

Once approved, you will receive up to six counselling sessions through our Pay As You Can model. You’ll choose a per-session rate that feels manageable for you. Your counselling agency will bill you for your selected portion at the time of each appointment, and Neoma Wellness will cover the remaining balance directly with the provider.

Your selected rate will apply to all six sessions, with flexibility to adjust if your circumstances change during the program.

Privacy & Confidentiality

Your privacy is important to us. Neoma Wellness will maintain strict confidentiality regarding your counsellor selection and payment arrangement. For administrative purposes only, you will be asked to provide consent for session dates to be shared with Neoma Wellness. No session notes or personal therapeutic information are ever shared.

Cancellations & Missed Sessions

We understand that life can be unpredictable. Neoma Wellness will cover the cost of one missed counselling session per calendar year, no questions asked.

Whenever possible, please provide your counsellor with at least 24 hours’ notice if you need to cancel or reschedule. This helps ensure our resources can support as many women as possible. Any additional missed sessions without notice will be the client’s responsibility.

First Name

Last Name

Phone

Full Mailing Address

Do you currently have a counsellor?

IF YES: Please provide agency name and phone number.

I agree to the Privacy and Confidentiality agreement

I agree to the Cancellations & Missed Sessions agreement

Consent & Review

By submitting your application, you confirm that the information provided is accurate to the best of your knowledge and understand that submission does not guarantee acceptance into the program. Applications are reviewed with care, and eligibility is determined based on available funding.

You’ll be asked to acknowledge:

Your selected per-session contribution
The six-month funding period (with the option to reapply)
The Missed Session Policy outlined above

Our team will review your application and contact you within 2–3 business days.

If you have any questions at any point, please reach out to us at info@neomawellness.com

You are not alone and we’re honoured to support you on this journey.

Thanks for submitting.