Section 1 of 4
Sharing Our Space at Ash & Birch Counseling
Welcome and thank you for your interest in leasing space at Ash & Birch Counseling! We’re excited to connect with professionals who share our commitment to quality care and a collaborative environment. Please complete the following application and upload any supporting documentation. We will review your submission and be in touch shortly.
If you have any questions, don’t hesitate to reach out to us at hello@ashandbirchcounseling.com—we’re happy to help!
Legal Name:
Legal Name:
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Preferred Name:
Preferred Name:
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Pronouns:
Pronouns:
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Email:
Email:
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Phone Number:
Phone Number:
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What is the name of your business?
What is the name of your business?
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Do you carry your own liability insurance (including general liability)?
Do you carry your own liability insurance (including general liability)?
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Yes
No
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Please upload business licenses documentation and liability insurance.
Please upload business licenses documentation and liability insurance.
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Do you consent to us performing a background check on you?
Do you consent to us performing a background check on you?
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Yes, I consent to a background check
No, I do not consent to a background check
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Feel free to add any comments on the above:
Feel free to add any comments on the above:
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Section 2 of 4
Professional Background:
Section 3 of 4
Your Availability:
When do you want to start using the office space?
When do you want to start using the office space?
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How many office spaces do you want to lease?
How many office spaces do you want to lease?
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How long would you like to lease the space?
How long would you like to lease the space?
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6 Months
12 Months
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What day(s) of the week would you like the space(s)?
What day(s) of the week would you like the space(s)?
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Sunday
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Section 4 of 4
Compatibility:
How do you handle conflicts or disagreements with others?
How do you handle conflicts or disagreements with others?
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What is your approach to maintaining a clean and professional office environment?
What is your approach to maintaining a clean and professional office environment?
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This office is a non-diet and weight-neutral friendly group practice. Is this compatible with you and your practice philosophy or would it present any conflicts for the work you intend to do with clients? (Please provide examples).
This office is a non-diet and weight-neutral friendly group practice. Is this compatible with you and your practice philosophy or would it present any conflicts for the work you intend to do with clients? (Please provide examples).
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Anything else you'd like to add?
Anything else you'd like to add?
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How did you hear about us?
How did you hear about us?
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