Are you a licensed trauma-sensitive health care provider?

Are you (or do you know) a state licensed “trauma sensitive” health care provider? Our clients and therapists are looking for collaborative practitioners!

Do you screen for trauma in your practice, and make referrals to psychotherapists trained in trauma resolution?
When you provide us your contact information, we will contact you (or the provider) in the future with more information. Thank you for letting us know about you!

 

Who are you? 

The health care provider  
An individual submitting provider information

If you are not the provider, fill out the form with what you know about the provider.

 

PROVIDER INFO

 

First Name

Last Name

Middle I.

Credentials (Initials after your name)

State licensure (if applicable)

What is the nature of your service?

Do you consider yourself …

A traditional health care provider
An alternative health care provider.
Both traditional and alternative.

Company Name

Address

City

State

Zip Code

Business Phone Number

Other Phone Number

FAX Number

What percentage of your clients are trauma survivors?

Do you presently screen for trauma in your practice?

Yes
No, but I plan to start.

Do you presently make referrals to psychotherapists trained to handle trauma?

Yes
No, but I plan to start.

Do you presently make referrals to psychotherapists trained in EMDR?

Yes
No, but I plan to start.

Please describe your experience with trauma.

Please describe any education or reading you have done about trauma.

Do you want to accept clients into your practice that may require extra sensitivity because of trauma or PTSD symptoms?

No
Yes

Would you be interested in being listed on this site?

No
Yes

Your name (if you aren’t the provider)

Your email (if you aren’t the provider)

Your phone (if you aren’t the provider)

Thank you very much for the trust you show in providing this information. Our readers and therapists will appreciate knowing about you!
Inner Courage LLC



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If you agree to the Terms of Use, please type "yes" in the above "I AGREE" box, and hit the "SUBMIT" button below. (We can't use the data without agreement to the terms of use.) An email will pop up with all the data you have filled out above for your review. However, you must "SEND" the email in order for it to be submitted!

You will get an automatic acknowledgement after you send the email and another one when we have received and read your email. In the future, we will have a more sophisticated system in place to collect data, so please be patient with us as we develop this site. Thank you! Inner Courage LLC

 


   

Thank you for providing your contact information and letting us know about you. Our clients and therapists are looking for collaborative practitioners! We will contact you (or the provider) in the future with more information. Inner Courage LLC

 

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