Portland Integration Network - Provider Application Form
The Portland Integration Network is a centralized online platform hosting local private practitioners, offering psychedelic education, preparation, and integration with ethical and best practices for care.

Our mission is to cultivate a local interdisciplinary community of providers and practitioners passionate about supporting the healing potential of psychedelics.

Please fill out this application to the best of your ability, and, upon review, we will be in touch to schedule a short call screening and get to know you call. If it feels like a good fit for all of us, we will send you further next steps, agreement form and payment set up.

To support the cost of maintaining the website and advertising we will charge fee of 15$ per/mo. Funds will also go to creating local and online events that are accessible to the public

Being listed on PIN you receive the following:
 
-A profile listing on the website including phone, website, email, bio and listing of groups, workshops and trainings

-Advertising of PIN that reaches beyond Portland, Oregon

-Access to a monthly, drop-in consultation group focused on psychedelic integration, facilitated by a member of the PIN community

-Ability to contribute to the PIN blog to share stories, about your practice, or any areas of expertise

-Membership within a thriving and growing community passionate about the healing potential of psychedelics with ethical and quality standards of care
 
-Connection to other providers through PIN’s Google Group/listserve to share resources, provide and request referral support, and consult with other providers, etc.

-We will have a blog hosting local providers and their work to be shared as a resource through PIN. You are welcome to offer to the blog, in support of providing more education to our community and gaining visibility of your passion and work in this growing field

Thank you for your interest to be a part of the Portland Integration Network! We are looking forward to connecting and co-creating with you!

 ~The Portland Integration Network Team


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First Name *
Last Name *
Email *
Profession *
Degree(s) *
Phone *
Website *
Mailing Address *
Name of Practice or Clinic *
License Type, Status, & Number (if Applicable) *
Insurance Accepted (If Applicable) *
Description of Services: Tell us about the types of services that you offer, i.e. psychotherapy, art therapy, body work, etc. *
Public Bio - 110 Words *
Sliding Scale? *
Years Practicing *
Additional Education & Training Background *
Specialty Areas of Service *
Other Information You Would Like us to Know
How did you hear about PIN? Thank you!
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