How to Apply

Application Process

By establishing this website, “Teejuh’s” goal is to display to the caller a safe, and confidential way to request help.

If the caller would like to request “Counseling Services,” Teejuh has eligibility requirements to meet, through a “Grant,” aligned to 40002(b)(2) of the Violence Against Women’s Act, as amended (42 U.S.C. 1395(b)(2)).

To help guide the caller, he/she can read the following documents Patient Admission & Eligibility and the Policy & Procedure: Program Eligibility, which will detail to them, our eligibility protocols for services.

In addition to eligibility requirements, the caller will need to complete the Registration Application which will be needed for our medical provider of record.

Once the form is completed, it will automatically be submitted to “Teejuh’s” program director for processing and/or following-up.

If you choose to print the form, please print, complete and bring it with you to your appointment.

Patient Admission & Eligibility

Policy & Procedure: Program Eligibility

Online Registration Application

Print Registration Application

Telemedicine Consent Form

We thank you for visiting our website, by reviewing, calling, and requesting help. This is your time, we’re here for you, and will stand by your side! Please know, we are available either by hotline or by calling “Teejuh’s,” main office on our contact page. This contact page will allow you to enter/type questions, request support, and if needed, to speak to us again. In closing, the hardest part of any journey and for healing is, “to move forward, you must first take a step,” –Chase S.M. Neill.