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Therapist Onboarding Form

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Section 1: Personal Information

Full Name

Preferred Name

Phone

Upload Professional Photo

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Section 2: Professional Bio & Education

Short Bio

Social Link 1

Social Link 2

Social Link 3

Highest Degree Earned

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Section 3: Professional Experience

Years of Clinical Experience

Special Populations Worked With

Past Employment/Practice Locations

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Section 4: Modalities and Approaches

(Select all that apply or add your own)

Cognitive Behavioral Therapy (CBT)

Eye Movement Desensitization and Reprocessing (EMDR)

Internal Family Systems (IFS)

Somatic Experiencing

Polyvagal Theory

Trauma-Focused Therapy

Solution-Focused Therapy

Mindfulness-Based Therapy

Other modalities if applicable

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Section 5: Services Offered

(Select all that apply)

Individual Therapy

Couples Therapy

Family Therapy

Group Therapy

Life Coaching

Public Speaking

Other services if applicable

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Section 7: Licensure Information

License Type

License Number

State of Licensure

Certifications

Consent and Submission

I confirm that all information provided is accurate and consent to its use for onboarding and public-facing materials such as the website.

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