Request An Account

Request Psychotherapy-Netork Account to be created for you.

Use this form if you do not have a PayPal Account to have an account created and an invoice emailed to you.

For Psychotherapy-Network provider use only. Any other use is prohibited.

Subject

Name (required)

Email (required)

State and License Number (required)

Manual Invoice Request:

Please E-mail a Paypal invoice and manually set up my Membership account.

Practice Profile Information:
Please list and index my website on the Psychotherapy-Network:
http://www.

Office location:

Additional Office Location:

Practice Description:

Client contact phone number:

Your Message

Please FAX this information to 877-396-0441:
Set your FAX resolution to "s.fine" so that small print is legible.

(a) Proof of an unencumbered state licensure and federal NPI number in a professional psychotherapy field in the state where you are marketing your services.

(b) Proof of current malpractice insurance with minimum limits of $1,000,000/$2,000,000.

In order to send this email you must check confirm Acceptance:

I will send the FAX.

I certify that I am a credentialed licensed therapist with an unencumbered license and active malpractice insurance with minimum limits of $1,000,000/$2,000,000. I will notify psychotherapy-network if the status if my licensure or insurance changes while a Member of Psychotherapy-Network.com.

I have read and agree to the Terms of Service.

After your request has been a approved you will be invoiced. Once payment has been received you will be notified by email that your account has been created with a WordPress site ready for your use.

Please type this code in the area below:

Use the following link to the Jumpstart Request Form to provide details for your profile and website. If your account has not yet been created then you will not have a UserName so just enter TBD. This form will require you to enter text to describe your practice and optionally attach your photo & header image for your website. Unless you suggest another theme, the default themplate used to create your site will be the Mobile Responsive Theme

Jumpstart Request Form

Disclaimer

Psychotherapy-Network.com is an independent online publisher of mental health information and resources. Psychotherapy-Network.com provides advertisement for psychotherapists, not recommendations. Psychotherapists are referred to as “practitioners”.

The contents of this site are for informational purposes. Nothing found on Psychotherapy-Network.com substitutes for professional psychological, psychiatric or medical advice, assessment, diagnosis, or treatment. In other words, always seek the advice of your physician or qualified mental health provider with any questions you have regarding the type of treatment best for you. Never disregard professional advice or delay in seeking it because of something you read on this website. The Psychotherapy-Network.com Provider/Pracitioner information is offered solely as a courtesy to visitors of our site.

Psychotherapy-Network.com recommends that you check the certification and/or licensing of any mental health professional or other health care provider with the applicable state licensing Board or authorities and that you verify that the professional or treatment facility has current malpractice insurance coverage.

Psychotherapy-Network.com does not examine, determine, or warrant the competence of any mental health professional listed. Psychotherapy-Network.com does not endorse the accuracy or reliability of any information displayed, uploaded, or distributed through the Psychotherapy-Network.com. By proceeding into this website, you acknowledge that you accept full responsibility for any decision you make based on the information you encounter herein.

Reliance on any information provided by any person or professional appearing on Psychotherapy-Network.com is solely at your own risk. Psychotherapy-Network.com is not liable for any advice or information provided on the site, all of which is provided on an “as-is” basis. Use Psychotherapy-Network.com to locate a mental health professional or facility is wholly voluntary and will not result in any liability against Psychotherapy-Network.com . In no event shall Psychotherapy-Network.com be liable for damages to any user of the directory for the voluntary selection of any professional or facility, for the services provided by any professional or facility listed therein, or for any other damages which may occur. Psychotherapy-Network.com cannot and does not provide any warranties related to the information contained in or resulting services from a professional or facility listed in the directory. No warranties, either express or implied, are made on the information we provide.

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