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CONFIDENTIAL

Client Registration

Thank you for your interest in becoming an Open Path member. We look forward to receiving your registration form. Please know this form is only shared with Open Path staff and the therapist that you have chosen.

To register, fill out our simple online client registration form and pay a one-time, lifetime fee of just US$65, which powers our nonprofit and makes therapy accessible for as many people as possible. You can learn more about why we charge a membership fee here.

If you have any questions, we are also available by direct email and live chat:

Registration
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Required Only if Client Is A Minor
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Please make sure your email address is correct, as email is our primary method of communication with members.
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Please format as mm/dd/yyyy (e.g., 01/23/1970)
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Please Select All That Apply
YOUR ADDRESS
Street address, P.O. box, c/o
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Apt, Suite, Office, etc.
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INSURANCE AND FINANCIAL INFORMATION
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This could include yourself, spouses/partners, parents, grandparents, children, etc.
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This could include yourself, spouses/partners, parents, grandparents, children, etc.
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If you have an annual household income greater than $100,000, you are not eligible for this program
Additional Financial Information

Please fill out this section in detail. You can write "0" if a certain field does not apply to you (e.g. childcare expenses). Your responses will help us understand your financial situation and determine your eligibility for this service.

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Please keep your response to 50 words or less
THERAPY
Please make sure you select a therapist from our database, and provide their name.
Please also make sure the therapist you've chosen practices in the same state where you live.
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To better serve you, please select the modality of counseling you would like to receive:
Please select a therapist, or search for one in our directory.
Should an in-office therapist not be available in your area, would you be willing to work with a clinician in your state by telephone or face-to-face using an internet-based video service?
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Reduced session fee agreement
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Please format as mm/dd/yyyy (e.g., 01/23/1970)
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By typing your full name here you certify your agreement to the above clauses and you agree to our Terms of Service
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Next Steps
After you submit your registration form, we will guide you in how to pay Open Path’s US$65 membership fee. After the fee is paid, we will email your Open Path Member ID. You can use the Member ID email to show your therapist that you are an Open Path client. This email will contain your therapist’s contact information. Please note that all of the information contained in this registration form is for Open Path’s administrative use only. It will never be made public under any circumstances and will only be shared with your prospective therapist.

If you are in a life threatening situation, do not use this site. Call the Suicide and Crisis Lifeline, a free, 24-hour hotline, at 988. Your call will be routed to the crisis center near you. If your issue is an emergency, call 911 or go to your nearest emergency room.
For quicker processing of your membership, please use the same email address in your registration and payment forms.

If you are in a life threatening situation, do not use this site. Call the Suicide and Crisis Lifeline, a free, 24-hour hotline, at 988. Your call will be routed to the crisis center near you. If your issue is an emergency, call 911 or go to your nearest emergency room.

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