OOTify | Clinical Application
OOTify Clinical Application for Mental Health Professionals
Email address *
First Name *
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Last Name *
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Phone Number *
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Professional Title *
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Primary Location *
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Areas of Specialty *
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Do you have a professional website? If so, please include the URL below. *
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How did you hear about OOTify? *
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What are you hoping to get out of being a provider on our platform? *
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What are your hours of availability? *
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What is your hourly rate? *
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Do you offer services on a sliding scale? If so, what is your range? *
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What is your preferred stream of communication? *
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Please describe your ideal client. *
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Are you licensed within the state of CA? If not, where are you licensed? *
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What is your license number? *
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Do you have an NPI number? If so, please provide it here. *
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How long have you been practicing? *
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Do you carry liability insurance? If so, please provide your policy number here. *
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If you have liability insurance, does it cover telehealth? *
Do you belong to any professional organizations? If so, which ones? *
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Do you have experience using telehealth services? If so, please describe. *
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What is your level of experience with motivational interviewing? *
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Are you trained in any treatment modalities? What is your clinical orientation? *
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Tell us about a challenging clinical case and how you handled it. *
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What does your self care practice look like? What do you do for fun? *
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What is your level of comfortability providing brief therapeutic support? *
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Do you have any leadership experience? If yes, please describe the role, organization, and time period. *
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What are your long term professional goals? *
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Do you have any experience running workshops? *
Vignette #1: You match with a client who said she lives in California (where you are licensed) as you continue to work together, she reveals that she actually lives in Oregon, but listed on her form that she lives in California because she is moving soon and didn't want to have to switch therapists when she moved. What would you do? *
Your answer
Vignette #2: A client with a history of self-medicating reports recently breaking up with her partner and is feeling extremely depressed. At the end of your session, she says, "None of this matters anyway. I can't wait to get it over with". How do you respond? *
Your answer
Vignette #3: Client has issues with behavioral self control. He states that he sometimes flares up quickly, and has angry outbursts. He states that though he doesn't drink daily, when does he can have up to 6 drinks at a time and acknowledges that he may have a "problem". His father was an alcoholic. How do you respond? *
Your answer
Are you presently in, or have ever been in psychotherapy? *
Have you ever been subject to disciplinary action, placed on probation, or terminated from an academic setting or clinical position? *
Have you ever been convicted of a felony or reported for sexual misconduct with a child or adult? *
Which of our core values resonates with you the most? *
Have you downloaded the mobile application and gone through the "Give Help" Onboarding bot?
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Would you like to be featured on our platform as a "Featured Provider"? *
A copy of your responses will be emailed to the address you provided.
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