This application is for individuals seeking services from Haven Haus clinicians that are: uninsured, underinsured, or cannot afford their full cash pay amount. Submitting this application notifies our team of your level of financial investment in services and your remaining financial need. Please complete the application in its entirety. *Incomplete applications will not be reviewed. You will be notified within 3-5 business days of the status of your application and the amount of financial assistance available to you for services with a Haven Haus clinician(s). Haven Haus currently has a wait list for those seeking financial assistance and cannot guarantee assistance for all applicants. If you have additional questions regarding this application, contact our team at admin@blkhaven.com. The 988 Suicide & Crisis Lifeline provides 24/7 free and confidential support if you or someone you know is experiencing a suicidal, mental health, and/or substance use crisis. Call or text 988 for confidential support with trained crisis counselors.