we can’t wait to meet you. Name * First Name Last Name Preferred Name Preferred Pronouns Email * Phone * (###) ### #### May we ask where you reside (city and state)? * License type * State(s) of licensure * License number(s) * Desired client hours per week * Availability * Desired mode(s) of treatment * Online therapy only Online therapy and in-person therapy Desired in-person location (if applicable) Please describe any prior experiences (positive and/or negative) providing online therapy. * Please tell us about your experience with private practice/clinical work. * What are your long-term professional goals (3, 5, or 10 years out)? * Please describe your therapeutic approach. * Please list any specialties, certifications, previous experiences, or unique trainings that enhance your therapeutic skills. * How do you help clients feel comfortable during their first session? * Would you be interested in optional case consultation groups and/or happy hours? * Please explain why you feel that Good Human Work would be a good fit for you. * Thank you!
