TheraFree Professionals Participation Interest Form

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Thank you for your interest in providing pro bono services. This form helps us match professionals with cases that align with their expertise and availability. Please provide the following details so we can coordinate appropriately.

Full Name *

Email Address *

Phone Number *

Professional Title and Credentials *

Organization/Institution (if applicable) *

Years of Experience in Your Field *

0-2 years

3-5 years

6-10 years

10+ years

Areas of Expertise *

Clinical Psychology

Behavioral Medicine

Therapy/Counseling

Forensic Psychology

Neuropsychology

Social Work

Other:

Required

Populations you're willing to see:

Adults

Older Adults

Teens

Children

Couple

Family

Veterans

Types of cases you're willing to take on:

Anxiety Disorders

Depression Disorders

Trauma Disorders

Developmental Disabilities

Personality Disorders

Other:

Preferred Case Format

In-Person

Telehealth

Either

How many cases are you willing to take on pro-bono?

Other:

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TheraFree Supervisor

Licensed Psychologist in the state of New Hampshire with active and unrestricted licensure.
Minimum of three years of clinical experience in a mental health setting.
Experience providing supervision to other mental health professionals.
Strong commitment to community service and improving mental health access.
Ability to provide telehealth supervision and consultation.
Knowledge of ethical and legal considerations in pro bono mental health services.

Are you willing to be the TheraFree supervisor, where you will oversee the program and will only be reached out to in cases of emergency?

Yes

Clear selection

Any additional comments?

Submit

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