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License Just as in your own practice, you are responsible to maintain your own professional liability coverage when working with Better Together© Groups. If you do not presently have professional liability coverage and do not have an insurance carrier in mind, contact us and we can try and assist.

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Me..    I'm a licensed.. Clinical Social Worker (LCSW,etc) Marriage & Famliy Therapist (LMFT, etc) Mental Health Counselor (LMHC, etc) Professional Counselor (LPC, etc) Psychologist

 

Primary license number    If you have more than one license, please provide the number you consider as your primary.

Primary State of licensure    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming US Territory

 

 Verify coverage amounts    Check the box above to verify your Insurance policy has miniumum $1 million single / $3 million aggregate limits. (Not sure? check your policy)

Upload your Proof of Policy document    A picture or digital copy are both good. The image needs to have both your Policy number, Insurance provider and Effective Dates of your coverage.

 

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Your areas of expertise Select from list and press..    Anger, Frustration, Agitation Anxiety, Worry Attention Deficit Hyper Disorder Autism Spectrum Disorders Bipolar Disorder Career / Profession Issues Chronic Illness Care giver support Depression, Sadness Loneliness and isolation Faith / Religion Family issues/ Conflict LBGTQ+ 65+ Issues Marriage/Couples Therapy Nutritional Health Parenting Pediatric Health concerns Significant Relationships Mood concerns Sleep disorders Substance abuse Trauma Recreational options Other Business/Professional Add Select as many items from this list as are applicable to you. Press "Add" after each of your selections.

 

 

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About you Finding the right clinician for a Group is what we do. Part of that is understanding a bit about you and your reasons for joining the Better Together© team. Just leave blank any questions you are not comfortable answering.

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How do you spend most of your professional time?    Online platform like Better Together Clinic or hospital Private practice Community mental health agency Teaching/counseling in an academic setting Other clinical setting Not currently practicing

 

How will you use Better Together©?    To build my own private practice To supplement my private practice To supplement my full-time job To supplement my part-time job Exploring becoming an Affiliate Other

 

How much time weekly do you intend to spend with Better Together©?    Up to 5 hours a week 5 to 10 hours a week 10 to 20 hours a week More than 20 hours a week Not sure

 

Where did you hear about Better Together©    Internet Research Friend or colleague Podcast Email outreach Other

 

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Belief Some Members request Groups composed of like-minded Members. The following questions are optional but can assist our AI in helping Members find optimal therapeutic settings.

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Religion in your life? Very important Important Somewhat important Not important at all Prefer not to say Would you say you're.. Spiritual Ethical Not spiritual Christian Muslim Jewish Hindu Buddhist Other Prefer not to say

 

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Personal Info

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Your age    We ask your age to assist us in filtering Members who request specific demographics; such as age. Please leave blank if you wish.

 

Your phone    We ask your phone as an emergency number. This number is confidential and is used only in extreme need.

 

Password    We suggest you create a password. You always have the option to use our OTP (multi-step authentication), but sometimes a password is faster.

 

Upload your picture or avatar    A picture or avatar is something we suggest. When you disable you camera, it replaces your video and also identifies you in chat and other sharing situations. If you don't have an picture or avatar, we will use what appears above.

 

Your Zip Code    If you filter Groups by location to you, we need your Zip code. Your Zip code is never provided to anyone and is confidential.

 

Fluent in a 2nd language?   Spanish French Portugese Italian Chinese Some Members request Groups in a second language. If you are conversationally fluent in a second language, please indicate it here.

 

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Acknowledgment ...... [Ranjit - make this checkbox the SUBMIT button]

 

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