DFW First Responders Support Network
Thank you for including your information in our support network directory. The information provided here, will be shared with the leadership of the DFW Scanner and with other members of this network. 
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What is your first name?  *
What is your last name? *
What are your credentials/title? (LPC, LMFT, LCSW, peer provider, LEO, student, board member, business liaison etc.) *
UPDATE: If you have registered for the directory before, please let us know if there have been any updates or changes since your last registration.
Important Note: If you mark yes, to ensure accurate information, please complete ALL sections of this form, even if only specific details need updating.

Please be advised duplicate entries will be deleted every 2-3 months. Your most recent entry with new updates will be retained.
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Phone number *
Email *
Experience: If you have lived experience as a first responder, have family members who are first responders, have  experience providing support to first responders, or their families, or have other experience that would be relevant to this population (ex: experience as a chaplain) please include that information here.  
What city are your services primarily located in? (If you are not a service provider, include what city you are working, living, or attending school in.)
The following questions apply to service providers, or those who would like to share their business/organization website and other service related information.

If these questions do not apply to you, you can scroll to the bottom of the form and submit. 
Website
Primary county you/your services are located in.
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Other counties served
If you are a service provider, what type of payment options do you offer? Mark all that apply. 
If you contract with insurance companies, please list which ones. 
If you are a service provider, what are your specialties? (Include any special certifications, or therapy styles you are trained or certified in (EMDR, CPT, ART, or programs you offer)
If you marked "other" above, please describe other trainings, or certifications you have here: 
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