Consultation Sign-Up Form:  CBT-Insomnia and CBT-Nightmares
Thank you for your interest in receiving consultation for CBT-Insomnia and CBT-Nightmares. Please complete this form and email it to: rubinmiriam79@gmail.com and CBTNIghtmares@MUSC.edu. In the subject line please be sure to include your full name and “CBT-I & N Consultation.” We will reply with the date / time of upcoming consultation groups, payment information, and responses to any questions.
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Email *
Name (please provide the name used to register for CBT-I or CBT-N training):  *
I am licensed independent provider of behavioral health/health services:  
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If Yes to previous question, do you have training in cognitive and/or behavioral therapy?
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State(s) where I am currently licensed (if practice outside of the U.S. please list country and location): 
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Type of Degree and discipline:
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CBT-I: I have completed training in CBT-Insomnia 
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CBT-N: I have completed training in CBT-Nightmares
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Type of CBT-Insomnia training attended:    

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Type of CBT-Nightmares training attended:    

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If you attended an  in person or virtual workshop, please specify date attended
(for workshops, please email a copy of the certificate of completion to rubinmiriam79@gmail.com and CBTNIghtmares@MUSC.edu) 
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I am interested in attending the following consultation group (please note times and start dates may be subject to change) : 

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I am interested in having my consultation hours count towards earning my Diplomate in Behavioral Sleep Medicine (DBSM)

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Questions or concerns regarding consultation (please also see FAQ’s for Consultation on the CBTN Website:   
A copy of your responses will be emailed to the address you provided.
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