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Elevation Counseling Therapist Questionnaire
Hello! Thank you for taking the time out to contact us about an independent contractor therapist position at Elevation Counseling. To streamline the process and be sure we are an appropriate match, please fill out this questionnaire. Thank you!
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* Indicates required question
Full Name
*
Your answer
Cell phone number
*
Your answer
Email address
*
Your answer
Are you fully licensed in New Mexico with an Independent License (must be an LPCC, LCSW, LMFT, LPAT, LP)? We cannot contract with providers with non-independent licenses.
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LPCC
LCSW /LISW
LMFT
LPAT
PhD Psychologist
I do not have an independent license/
Other:
Do you have an active New Mexico Medicaid provider number?
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Yes
No
I do not know
Please tell us about your specialty or niche. List any certifications, previous experience, or any other information that informs us about your ability to work with that population(s).
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Your answer
Have you worked as an independent contract therapist before (vs. working as a W2 employee)?
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Yes
No
Please describe any previous work as a contract therapist? (or say "N/A")
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Your answer
Have you used cloud based medical records software before (Therapy Notes, Simple Practice, TheraNest, etc.)?
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Yes
No
Why do you want to practice in a group practice? Why Elevation Counseling?
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Your answer
What are your typical note taking practices (when and where and how do you prefer to do your notes)?
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Your answer
Are there any ages or types of clients you prefer to see? Any that you prefer not to see?
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Your answer
Can you provide counseling sessions at least 3 days a week and / or at least 15 sessions per week?
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Yes
No
Other:
Would you like to see clients in our office, in schools, via telehealth or a combination? (check all that apply)
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In Office
Schools
Telehealth
Other:
Required
Credentialing and paneling with insurance can take up to two months. Are you able to wait a month or two before seeing clients through Elevation?
*
Yes
No
Other:
What are your main therapeutic modalities?
*
Your answer
Are you able to provide therapy in Spanish? (not a requirement)
*
Yes
No
Please describe your ideal schedule (days and times, number of clients/sessions per week).
*
Your answer
Are you interested in seeing clients nights and/or weekends?
*
Your answer
Anything else you would like us to know about you?
Your answer
Thank you for taking the time to respond. We will reach out shortly.
If you haven't already, please email your cover letter and resume to
office@elevationcounseling.com
.
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