RTB Preferred Provider Application Form
Root To Branch enacts our vision through providing services from a fully vetted network of preferred providers. Currently, our preferred provider network is full, but if you are interested in joining in the future, please apply here and we will be in touch!
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Your first & last name: *
Email: *
Phone number: *
What is your current licensure status & background (i.e. credential, states licensed in, and specializations)? *
Do you currently work independently or with a group practice? If with a group practice, please list the company name and your role at the practice: *
We require all providers to be fully trained in EMDR through an EMDRIA approved basic training. Please provide the date of your EMDR training and name of the trainer/facilitator: *
If you are an EMDRIA Certified therapist, please provide the date of certification and the name of your Consultant:
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