Age Check

What is your date of birth?(Required)

If you are under 18:

We hear you wanting support, and that matters. This is a reminder that before we can complete enrollment and begin sessions for teen therapy, we’ll need written consent from a parent or legal guardian. We’ll walk you through the process of getting parental consent, but for now, we’d love to help you find resources that can support you today.

988 Suicide & Crisis Lifeline

Call or Text: 988
Confidential, free support 24/7 for teens experiencing emotional distress, anxiety, depression, or thoughts of self-harm or suicide. Phone, text, and chat options are available nationwide.

Crisis Text Line

Text HOME to 741741
Free, confidential support via text message, available 24/7. Teens are connected with trained crisis counselors.

Teen Line

Call: 1-800-852-8336 (evenings)
Text: TEEN to 839863
Peer-to-peer support provided by trained teen listeners. Availability varies by day and time.

NAMI Teen & Young Adult HelpLine

Provides emotional support, education, and referrals for teens and young adults navigating mental health concerns. Contact is available via phone, text, or email through NAMI’s helpline services.

Boys Town National Hotline

Call: 800-448-3000
Text: VOICE to 20121
Available 24/7 for children, teens, and parents needing support with emotional or behavioral concerns.

The Trevor Project

Call: 1-866-488-7386
Text or Chat: Available through The Trevor Project website
24/7 crisis intervention and suicide prevention services for LGBTQ+ youth ages 13–24.

211 United Way

Dial 211
Connects individuals and families to local mental health resources, counseling services, and community supports. Not a crisis line, but helpful for ongoing care.

Emergency Services

If a teen is in immediate danger or at risk of harming themselves or others, call 911 immediately.

Location Verification

Which state do you currently live in?(Required)

We’re actively working to provide therapy services in your state. Fill out the rest of this intake and share your contact information at the end and we’ll be back in touch as soon as matching services are available in your area.

Gender Identity

How do you identify your gender?(Required)

I describe my gender as:(Required)

You should feel assured that your therapist sees and supports you for who you are. These questions help us match you thoughtfully.

Sexual Orientation

How do you identify your sexual orientation?(Required)

Remember: these questions are only used to help us match you thoughtfully.

Select which LGBTQIA+ orientation you identify as:

I describe my sexual orientation as:

Spiritual or Religious Alignment

Do you identify with a religious or spiritual practice?

Yes

No

Prefer not to say

Which religious or spiritual practice do you identify with?

Describe the religious or spiritual practice you identify with:

Your Pronouns

Your pronouns (optional):

You don’t have to share this if you’re not comfortable. This helps us address you correctly.

What pronouns would you like us to use?

Previous therapy

Have you ever been in therapy before?(Required)

Never

Briefly

For a few sessions

Over 10 sessions

School

Do you currently go to school?(Required)

Yes regularly

Yes, but I skip school sometimes

No

Current living situation

Where do you currently live?(Required)

At home with both parents

At home with one parent

Split custody with both parents

Other

Describe your current living situation:(Required)

Parent’s marital status

Are your parents going through a divorce?

Yes, currently

Yes, in the past

No

Self harm

Have you ever hurt yourself on purpose (cutting, burning, etc.)?(Required)

No

Yes

Prefer not to say

Final Step: Confirm & Continue

How we’ll connect: Care is provided via telehealth using secure electronic communication. You may withdraw consent at any time.

Consent to Treatment: I understand that I am consenting to receive mental health services through Breathable.

Privacy & HIPAA: My information is protected under HIPAA. I have reviewed the Notice of Privacy Practices.

Non-Emergency Disclaimer: Breathable is not an emergency service. If I am in crisis, I will call 911 or 988 in the U.S.

Terms of Service(Required)

I agree to the Terms of Service and Privacy Policy.

Telehealth Consent(Required)

I consent to care via telehealth.

First & Last Name:(Required)

First Last

Email Address:(Required)

Enter Email Confirm Email

This is how we’ll get back in touch with you once we’ve matched you with a therapist.

Phone Number:

Breathable does not provide clinical or therapeutic services. Licensed therapists deliver all therapy services independently. The platform charges through the Breathable platform. The total price you pay includes the professional fees for the therapy services, which are collected on behalf of the therapist and paid to the therapist, and separate administrative and technology fees for the non-clinical services, which are included in the total retail price paid by the customer. Administrative fees are not paid to your therapist but are included in the total retail price that the Breathable platform makes possible and that enables you, as the customer, to have seamless access to therapy services.