PPSM Integrative Medicine Provider Application
This form is used for those interested in being part of the PPSM Provider Resource List. This form is for those who are integrative (or complementary) medicine providers, such as acupuncturists, functional medicine, chiropractors, or any other modality that has certification or licensure.

PPSM’s provider resource list is a list of mental health, psychiatric, and integrative providers who have advanced training in treating PMADs. Over the years, we have created a database that has reputable providers that have been vetted, so that the community can have access to the best possible care. For these reasons, we have created guidelines for providers who are eligible to be listed in this database. We are looking for Competency, Commitment and Connection in the PMADs community.

Creating these requirements has given our organization credibility that we are proud of! We hope that you will be proud to be a part of our resource list.

Email address *
Today's Date *
Name *
What is the best phone number to reach you? *
What is the best email address to reach you? *
What is the address of your clinic location? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Additional Terms