TheraV Therapist Directory
Sign in to Google to save your progress. Learn more
Email *
What is the best phone number to reach you?
Do you want information on the online platform, the directory, or both?
Clear selection
Are you an individual therapist or a practice?
Clear selection
What type of therapy do you practice?
What states are you licensed in?
Do you have a single therapist practice or multiple therapists in your practice?
Clear selection
Do you specialize in anything? If so, what is your specialty?
Do you offer telepractice visits or just in person?
Clear selection
What age of clients do you see?
Do you have a preference in the types of clients you see?
Are you on insurance panels? If so, which ones?
What do you charge per evaluation, per treatment session?
Clear form
Never submit passwords through Google Forms.
This form was created inside of TheraV Network. Report Abuse