Couples/Relationship Therapy Interest Form Logo

  • Relationship Therapy Interest Form

  • This intake form is for relationship therapy, which can include couples, partners, friends, family, community members, and more. (Please fill out this form if you are seeking individual therapy.)

    Therapists at Alchemy offer weekly sessions with clients seeking ongoing talk therapy, either virtually or in-person at our office in Oakland. As a sliding scale clinic focused on mental health equity, with services ranging from $70-$300 per 50min session, at prorated rates for longer sessions. If you're hoping to work with a therapist at Alchemy, please fill out the form below. One of our therapists will reach out to you as soon as there's an opening.

    • Note: The only psychedelic-assisted therapy currently available in California is ketamine-assisted therapy. Other legal psychedelics therapies are still only available through clinical trials (clinicaltrials.gov).
    • If you are having a psychological crisis, please call Crisis Support Services of Alameda County at 1-800-309-2131 or the National Suicide Prevention Lifeline at 988.
    • If you're looking for other sliding-scale therapy resources, check out our list here.

    If you have any questions, please reach out to info@alchemytherapy.org

  • Due to licensing laws, unfortunately we are only able to provide services to California residents. 

    If you live outside of California, here are some resource lists that may help you find support near you: 

    • Inclusive Therapists
    • Open Path Collective
    • KRIYA Ketamine Providers
    • MAPS Psychedelic Integration
    • Psychable
    • Psychedelic.Support

  • Person 4 Info

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  • Demographic Info

    Please fill out as much of the demographic info as you feel comfortable sharing. We use this to make sure we're fulfilling our mission of providing equitable therapy to diverse populations.

  • Person 3 Info

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  • Demographic Info

    Please fill out as much of the demographic info as you feel comfortable sharing. We use this to make sure we're fulfilling our mission of providing equitable therapy to diverse populations.

  • Person 2 Info

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  • Demographic Info

    Please fill out as much of the demographic info as you feel comfortable sharing. We use this to make sure we're fulfilling our mission of providing equitable therapy to diverse populations.

  • Person 1 Info

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  • Demographic Info

    Please fill out as much of the demographic info as you feel comfortable sharing. We use this to make sure we're fulfilling our mission of providing equitable therapy to diverse populations.

  • Income

    If one person will be paying for the sessions, please have them fill out the income section. If payments will be split, please have the person with the highest income complete this section.

  • Sliding Scale Tool

  • Alchemy works as a sliding-scale clinic, a tool built to help repond to historic and present-day systemic imbalance of wealth in many marginalized communities. By creating a range of rates, we are able to support our mission of equitable access to mental health services for diverse populations.

    We've built the tool below to help you calculate where you land on our scale. Although we recognize financial security cannot be distilled to a series of questions, we hope this can be used as a good starting point to reflect on your resources and what you're able to contribute. We appreciate your transparency and honesty through this process.

  • Sliding Scale Payment

  • Therapy Info

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  • Ketamine Assisted Therapy

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