Pro Bono Therapy Sessions for First Responders for Los Angeles Fires

This form is designed for licensed or registered associate therapists who are legally being supervised to submit their information. The goal is to create a directory of therapists who are offering pro bono therapy sessions to first responders (firefighters, police, doctors, nurses, EMT, etc) or others who have been impacted by the Los Angeles fires (people who have lost their home, etc.) who cannot afford therapy.

The information provided will be shared publicly with those seeking support. Please ensure that all details are accurate and up to date.

**Please contact Robyn@alignedcarecenter.com once you have filled your pro bono spots to have your availability updated and moved to a different section of the list**

TO ACCESS THE LIST OF PROVIDERS, PLEASE VISIT THIS LINK

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Email *
Full Name (as it is listed with licensing board) *
How may first responders and others directly impacted (loss of home, etc.) contact you? (Please include contact information) *
What modalities are you trained in and can you competently provide? *
License or Registration Type and # *
If you are not yet independently licensed, what is your supervisor's name, license type and license #?
If you are not yet independently licensed, has your supervisor agreed that you may offer sessions pro bono?
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Preferred session format (e.g., telehealth, in-person, hybrid)

 *
If in-person, where is your office located?
Languages spoken *
Website or online profile *
I confirm that I can legally provide therapy or other mental health services to individuals located in California? *
If you are not licensed in CA, what state(s) are you licensed in? Thank you for being willing to support those who may need to relocate to other states and first responders who came from afar to help.
If you are offering pro bono support groups, please list the details here 
Please share any other details you would like about the pro bono services you are offering (limited sessions, etc.). This question was added 1/10/25 at 2:00 pm.
I consent to having my information shared with first responders seeking pro bono therapy sessions. *
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