To start, please give a few brief sentences about why you are interested in the program and any goals you have for a therapeutic strategy:

First Name *
Last Name *
Email *
Phone Number *
Country *
State

If your son or daughter is 13 or under we would love the opportunity to work with you and them. If they are 14 or older, we would like to refer you to a local certified provider, so the support received matches your needs better.

Age of individual(s) who will be using the Unyte Home Program: *

Please select any of the following that apply to you or the potential user of the program:

Substance abuse Severe depression/suicidal thoughts Bipolar disorder/multiple personality disorder/other personality disorders PTSD and/or multiple severe traumas Misophonia/tinnitus/hyperacusis/other severe auditory sensitivities Seizure disorder or history of seizures Taking any medications

If any of the following applies to you or the potential user, please fill out our Find a Provider form to connect with a certified provider working in your area.

I do NOT have a personal support system in place, for example ongoing therapy and/or a supportive family/friends structure