Application for TMP External Referral List
The Meeting Point is a collaboration of independent body workers and mental health practitioners devoted to social justice and multidimensional understandings of health and healing. If you would like to be considered for inclusion on The Meeting Point's list of providers we refer out to, please provide your information below.
Type of Practice or Services You Offer
Required
Name
Your answer
Degree(s)/Certification(s)
Your answer
Street Address Where You Practice
Your answer
City Where You Practice
Your answer
State Where You Practice
Your answer
Public Transportation Accessibility
Please describe how accessible your space is by public transportation (nearby bus lines, T stops, and so on)
Your answer
Contact Phone Number
Your answer
Contact e-mail (for our use only)
Your answer
Website (if available/applicable)
Your answer
Name & Contact Information for a Reference
Your answer
Types of Insurance Taken
Your answer
Describe payment options and sliding scale (if available)
Your answer
Areas/Populations in Which You Specialize
Required
Which of these communities/labels do you personally identify with?
This question is optional. We include it because some clients ask for clinicians that specifically match certain identities.
Do you offer tele-health services / meetings via videochat?
Contact Person inside The Meeting Point (if applicable)
Your answer
Would you be interested in renting space at The Meeting Point if we have open offices and/or expand into another building?
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