Please list your current insurance carrier.
List the College/University you attended, your Major, # of Credits, Degree and Date of Graduation.
List the name of the Institution, Course/Programs, Dates and Supervisors.
List your training & professional experiences, listing most current first. Include Dates, Client Age Range, Treatment Modality, Setting (Hospital/Clinic), Hours per Week, and Supervision (Type, Individual, Peer, Group, etc., and Frequency).
e.g. research, teaching, community work, writing, etc.
List the type of psychotherapy (individual, family, couples, group), the therapist's name(s) and theoretical orientation(s), when, how often, and how long.