Lotus Therapy Fund Application for Clinicians
Welcome to the CLINICIAN application form for Asian Mental Health Collective's Lotus Therapy Fund program! The goal of this program is to make psychotherapy as available, accessible, and approachable as possible to the Asian community.

The information on this form will only be used in connection with the work of Asian Mental Health Collective (AMHC). It will only be accessible to designated staff and members.

In order to be considered for this program, you MUST be: (1) a licensed or provisionally-licensed mental health professional in the US state(s) you serve, (2) able to provide culturally-competent clinical services to adults at least 18 years old*, and (3) listed on AMHC's US Therapist Directory online.

Clinicians selected to participate in this program may also: (a) attend any of AMHC's events for free or at a discounted rate, (b) receive training/CEs through our partners at a free or discounted rate, (c) be eligible to receive reimbursement for CEs (up to $300/year).

Please note, filling out this form does not guarantee immediate placement into this program. If chosen to join AMHC's Lotus Therapy Fund program as a provider, you will become part of a community of Asian clinicians who will receive subsidized payment for the equivalent of 8 therapy sessions (up to $125/session) per individual client in a given round. In order for individuals to continue receiving subsidized therapy, the client must reapply.

Please review our terms and conditions and fill out the therapy option form below. If you do not review and sign the terms and conditions, we are unable to accept your application. Also NOTE, by applying to be a provider for this program, you are agreeing to (a) charge your matched client a maximum fee of $125/session (minus processing fees that AMHC or its partners charge), and (b) receive vouchers equivalent to this amount for the time the client is receiving subsidized treatment through the Lotus Therapy Fund.

Thank you for your interest in helping AMHC further its mission of destigmatizing mental health for our community! Further information will be provided once your application has been approved and you've been accepted into the program.

*At this time, AMHC's Lotus Therapy Fund is available to US residents 18 years and older only.
Email *
First Name *
Last Name *
Email *
Phone Number *
Age *
Active State Licenses (e.g. CA123456...Please include the state) *
Type of Provider *
Required
Are you Fully Licensed or Provisionally Licensed? *
Required
Please tell us about why you would like to join AMHC's Lotus Therapy Fund program as a clinician. *
How many years of experience do you have working with the Asian population? *
How many years of experience do you have working as a clinician/psychotherapist? *
Do you have any clinical specialities? What areas do you treat? *
Populations you serve (Age) *
Required
Is this your first time applying for the Lotus Therapy Fund program? *
How did you hear about us? *
Are you listed on AMHC's US Therapist Directory? To apply, visit: https://www.asianmhc.org/apisaa-new-provider-form *
Are you a member of AMHC's Asian Mental Health Professionals (AMHP) Community? *
Terms & Conditions: You confirm that you, as the individual submitting this form, are the named clinician intending to provide therapy services, that you are a licensed or provisionally-licensed mental health professional in the U.S. state(s) that you serve, and that if you accept a patient, that you are fully competent to provide clinical services in the areas of specialization likely needed to treat the patient. If you are accepted into the Lotus Therapy Fund program, you agree to be listed in the AMHC U.S. Therapist Directory. You further agree that AMHC is merely providing financial support to patients and access to AMHC's US Therapist Directory. You acknowledge that AMHC, its partners, and its sponsors provide no warranties and have no liability for any services provided by or any issues related to therapists in the Therapist Directory. The Therapist Directory is a non-exhaustive, voluntary, unpaid listing of mental health professionals who are attempting to provide quality, culturally competent services but who are not endorsed by or are agents of AMHC. If you become a Lotus Therapy Fund clinician, you agree to accept the participant vouchers. valued at no more than $125 each (minus processing fees), as payment in full for services. Therapists are solely responsible for adhering to their professional responsibilities and legal requirements, including HIPAA and other compliance and reporting obligations, and for carrying appropriate liability insurance. Each therapist participating in Lotus Therapy Fund program agrees to relieve and indemnify AMHC for all liability relating to participants or issues in this program. By clicking yes below, you acknowledge that you fully understand the terms and conditions above and, if selected as a clinician, freely consent to abide by all rules and policies associated with the Lotus Therapy Fund program. *
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This form was created inside of Asian Mental Health Collective.