Provider Information

Name *

First Name

Last Name

Availability For Clients *

Check all that apply (there is no requirement to see clients in the evening or on weekends)

Weekdays during the day

Evenings

Weekends

Don't know/ to be determined

Populations Treated *

Check all that apply

Children

Adolescents

Adults

Older adults

Couples

Families

Evidence-Based Treatments Provided *

Check all the treatments below that you are an expert in

Beckian Cognitive Behavioral Therapy (CBT)

Acceptance and Commitment Therapy (ACT)

Dialectical Behavior Therapy skills (DBT) (we do not provide full-model DBT)

Cognitive Processing Therapy (CPT)

Prolonged Exposure Therapy (PE)

Trauma-focused CBT (TF-CBT)

Seeking Safety

Exposure and Response Prevention (ERP)

Exposure therapy for social anxiety

Exposure therapy for phobias

Cognitive Behavioral Therapy for Insomnia (CBTi)

Unified Protocol (UP)

Motivational Interviewing (MI)

Habit Reversal Training

Mindfulness-Based Cognitive Therapy (MBCT)

Couples therapy: Integrative Behavioral Couple Therapy (IBCT)

Couples therapy: Gottman Method

Couples therapy: Emotionally Focused Couple Therapy (EFT)

Presenting Issues *

Check all the presenting issues that you are very comfortable treating

Depression/major depressive disorder (MDD)

Generalized anxiety disorder (GAD)

Social anxiety

Specific phobias

Panic disorder/ panic attacks

OCD

Trauma/PTSD

ADHD

Chronic health issues and chronic pain

Bipolar disorder

Psychotic disorders

Sleep disorders

Insomnia

Neurodivergence and autism spectrum disorder

Borderline personality disorder

Other personality disorders

Substance use

Smoking cessation

Binge eating disorder

Restrictive eating disorders

Body image issues/body dysmorphia

Intuitive eating

Tic disorders

Trichotillomania

Excoriation disorder

Anger management

Perinatal issues

Racial stress and trauma

LGBTQIA2S+ concerns

Gender dysphoria

WPATH letters

Sexual issues and sexual dysfunction

Dissociation and dissociative disorders

Grief/bereavement

Self-harm/self-injurious behavior

Other (please elaborate below)