Pro Bono Therapy for Healthcare Crews & Farmworkers
This is the application for Latinx mental health professionals. Therapists who sign up should have an active license & their own malpractice/liability insurance.
Associates are welcome, but must have explicit permission from their supervisor. Everyone will be practicing under their own license & insurance.

This is a Latinx Therapy nationwide project to create accessibility in individual therapy services to Latinx and Spanish-speaking individuals (such as farm workers, and janitorial workers) with the criteria listed below.

Participants seeking pro bono therapy services must be:
- low-income &/or uninsured
- high-risk "behind the scenes" work positions potentially exposed to COVID-19 patients/individuals
- be working during COVID-19
-work in agriculture/farm worker or be in janitorial services

The mission of this to alleviate the stress of finding a Latinx Therapist and give back to our community that has been at the frontline during this pandemic.
The services are temporary, but ultimately, length of sessions are under discretion of each therapist. Although a sample consent will be provided upon request, it is the responsibility of each therapist to change it per their policies.

Sessions are to be provided via phone or online (video by phone or by computer)- please be as flexible as possible since most individuals may have a hard time with technology or not have access to it.
Please list your phone number, if comfortable as preferred method.
Full Name of Provider (as shown in license): *
Number where pro bono client should reach you: *
Best contact method from client, if phone is not preferred (include email): *
If email, please include the email for clients to reach you.
What cultures do YOU identify with? What are YOUR cultural identities? *
Please list who your services are appropriate for (such as age range or specialties within THIS project for farm workers and janitorial workers):
Are you trauma-informed? *
Which states are you licensed in? No acronyms please. (Ex: California) *
What is your license type (spell out) and license number? *
Example: Licensed Marriage and Family Therapist 99999 - No acronyms please
If you are an associate, please enter your supervisors name, license type, and state where supervisor is licensed.
If you are an associate and no supervisor information is entered, your information will be deleted.
To confirm, check ALL languages you can fluently provide services in: *
Required
Please tell us which system you will be using to conduct sessions while the stay-at-home order is in effect: *
Simple Practice, Doxy.me, etc
If you accept insurance, please list the insurances you accept. Clients will be asked if they have insurance & select from our providers who accept those insurances.
How many pro bono slots will you have available? As in how many people can you see pro bono? *
How many probono sessions are you able to provide? List number of sessions below please (X per client). *
Probono availability *
Required
Availability for ProBono Sessions- Days of The Week *
Required
What date will your probono services expire? If you have one.
MM
/
DD
/
YYYY
Will you need a pro bono consent form?
If yes, email us upon receiving your first client. Support@latinxtherapy.com
Clear selection
Please check 'yes' to indicate that you understand that you are volunteering and will not receive compensation for this community service. You also understand that you are providing your own liability & telehealth insurance. * *
Do you have any questions?
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