Associate Therapist Interest

Please complete this brief form if you're interested in learning more about potential opportunities with me. I'll be in touch to discuss next steps.

Name

First Name

Last Name

Qualifications

Are you currently registered with a professional body?

Yes

If yes, can you provide more information?

Phone

(###)

###

####

Years of experience

Primary speciality/specialities

Secondary areas of interest

Supervision arrangements (current/needed)

Your current fee for therapy

Delivery preference

In-person

Online

Hybrid

Preferred location (if in-person)

Preferred client age groups

Therapeutic modalities you practice

Do you have your own therapy room currently?

Technology comfort level (booking systems, video calls)

What would make this opportunity perfect for you?

Anything else you'd like to know?