Postpartum Support International Certification in Perinatal Mental Health: Initial Intake Form
Thank you for your interest in the PSI Certification in Perinatal Mental Health. In order to ensure that you meet minimum requirements for this certification test, please take a moment to fill out the following questionnaire. Please be aware that you may be asked for additional documentation to determine eligibility.

Once it is determined that you meet eligibility requirements, you will be directed to register for the test at your nearest testing center directly through Pearson VUE. Testing centers are available throughout the world and will be found on the Pearson Vue/PSI webpage.

At this time, all PSI CPMH tests are delivered by computer at Pearson VUE testing centers. For more information about the test and requirements, please visit: http://www.postpartum.net/professionals/certification/.

This form will allow you to accomplish two things:
1. It will allow you to create an account within the PSI management system, so that we can track your testing history, scores, and recertification status.
2. It will give you the ability to provide details about prior trainings and other related documentation.

Please email certification@postpartum.net with any questions. You will receive a copy of your answers to the questions below as well and followup regarding registration status (approved, pending, etc.) Thank you!

Email address *
First/Given Name (Please make sure this information matches your identification, which is required for testing at Pearson VUE centers): *
Middle Initial/Name:
Last Name (Please make sure this information matches your identification, which is required for testing at Pearson VUE centers): *
Date of Birth *
MM
/
DD
/
YYYY
Identifying Gender: *
Preferred Email Address: *
Country/Location: *
Address Line 1: *
Address Line 2:
City: *
State/Province (if international) *
Zip Code: *
Primary Phone Number: *
Alternate Phone Number:
Which specialty area best matches your professional experience and certifications? This is important for determining eligibility to sit for the certification. (Please only choose one option.) *
Next
Never submit passwords through Google Forms.
This form was created inside of Postpartum Support International. - Terms of Service