Counselling Applications.

In 2020, amounts raised for Andrew's Fund covered 80 professional counselling sessions for individuals that were battling depression or affected directly by the suicide of another person. 

In 2021, the Dayna Karle Memorial Campaign was created to help bridge another gap in vital mental health services for women struggling with mental health issues and addictions.

To date, over 300 sessions of specialized trauma-focused counselling have been provided to applicants through these campaigns, free of charge.

Together, we can do more.

How to Apply.

See below for the application form for clients to complete if they are in need of funding for private crisis counselling services. 

Once the form is completed, KMH Foundation will review the request and determine eligibility based on need, available funding, and availability of qualified practitioners to provide the service. 

Counselling Funding Application Form A

    Available Funding

    This funding will cover the cost of private crisis counselling sessions for clients residing in Thunder Bay, Ontario and remote surrounding areas where services can be difficult to access.
    As funds are gathered through public donations, funds are limited. Applicants are encouraged to use any other available sources of funding first.

    Eligible clients can apply for 6 sessions within a 6 month period performed by an enrolled provider on a fee-for-service basis.
    ​
    Fees for services are rendered directly to the registered provider and may only be used to pay for psychotherapy or counselling services. Claim forms cannot be processed without a registered claim approval number provided by KMHF. Fees for cancellations, no-showed appointments, or any other service outside of direct counselling are not covered through this fund.

    Provider Criteria

    Providers wishing to become members of KMH Foundation's Network of Community Resources can apply by contacting us at [email protected]. 

    Therapists must be registered in good standing with a legislated professional regulatory body and eligible for independent practice in the province/territory in which the service is being provided. We are currenty recruiting the following providers for our network:
    • Master-Level Psychotherapists, Registered with OCSWSSW, CRPO, or CPO
    • Preference given to therapists with trauma-focused practices
    New providers wishing to deliver services reimbursed by KMH Foundation must complete a Mental Health Counselling Provider Agreement form.

    Please email [email protected] for further instructions.

    Application for Counselling Coverage

    Symptoms

    Please check all that apply.

    History


    ​​*If you have attended counselling sessions in the past or are currently attending counselling, please have your therapist complete Form B (below) and submit with your application*

    Acknowledgements

    A note on confidentiality:

    Submitted applications are confidential, and you can expect that your personal information is protected per the Personal Health Information Protection Act (PHIPA, 2004). ​
    If you have answered the above questions to the best of your ability, please click submit. Please ensure that your contact information is correct, as a representative from KMH Foundation will be in touch with you as soon as possible.

Counselling Coverage Application Forms

For your convenience, we have created online forms (below) that can be completed and submitted directly through our website. Additionally, you can download the pdf files below and email them to us at [email protected]. 
Form A (Application)
File Size: 591 kb
File Type: pdf
Download File
Form B (Therapist Comments)
File Size: 155 kb
File Type: pdf
Download File

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