Interested in joining Prescriptive Behavioral Health (Clinicians only)?
Prescriptive Behavioral Health
Email address *
First name *
Middle Name *
Last Name *
Phone number *
Does your phone receive text messages? *
Are you licensed? *
What is your license? *
Required
What is your license number? *
What is your NPI number?
Do you have another license type not listed above? *
When were you licensed or type not applicable? *
Are you licensed to practice in California? *
Are you able to provide services speaking in a second language? *
What other language to you speak? *
Are you interested in having insurance claims and collections completed for you? *
Do you require supervision to practice? *
About how many clinical hours do you need? *
Do you have malpractice insurance? *
Areas of interest? *
Can you prescribe medication? *
If you are a nurse practitioner, do you need a consulting physician? *
Do you lease or rent your own office? *
What is the address of your office? *
Do you have a private practice? *
Where do you work at this time? *
Where would you like to treat clients? Which city or cities? *
Do you rent or lease a private office? *
How many hours per week are you thinking about in terms of private patients? *
The system will allow you to meet with clients via online secure video. Do you have interest with offering this service? *
Do you have a CAQH number? *
Are you interested in supervising? *
Are you interested in serving as a consultant? *
Please list your insurance contracts that you have in place at this time? *
Are your current insurance contracts individual or with another group? *
Reasons for contacting with Prescriptive Behavioral Health?
Column 1
Help with submitting claims.
Help with collecting payments.
Higher insurance group rate.
Able to consult with group members
Able to use my own office.
Want to keep control of my clients.
Getting paid on time every month.
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This form was created inside of Psychological Behavioral Health.