Staff Therapist Contact and Bio Form

Name

Enter your name and credentials as you'd like them to appear on your business cards and website profile.

First Last

Post Nominal Initials

MFT, LCSW, etc.

Title for Business Cards

i.e. Couples Therapist, Licensed Psychologist, etc.

Council for Relationships Email

Council for Relationships Extension Number

Office Location(s)

Atypical Hours at Office #1

Saturday
Sunday
Early Mornings
Other

Please provide any additional information about your hours at office #1 that you'd like prospective clients to know:

Atypical Hours at Office #2

Saturday
Sunday
Early Mornings
Other

Please provide any additional information about your hours at office #2 that you'd like prospective clients to know:

Media Opportunities

Yes, I would like to be contacted for media opportunities, i.e. written commentary, TV and radio appearances, etc.
I'm not sure and I'll reach out to learn more.

Alternate Email Address for Media Inquiries

Cell Phone for Media Inquiries

Bio

Paste a short professional bio below with your education, background, and expertise. Write in the third person (John Doe, MFT graduated from...) and err on the formal side. The goal is to connect with your ideal client. You can browse our therapist directory for example bios. Your bio should be a minimum of 5 sentences.

In Print

You can paste links to articles, books, or blog posts, that you've authored. You can also upload files (Max 1MB) that you would like linked from your profile.

File Upload

Drop files here or

Accepted file types: pdf, doc, Max. file size: 1 MB, Max. files: 5.

Specialty Areas (ONLY select between 5 - 7)

Types of Therapy

Ages of Clients

Children
Teens
Young Adults and College Students
Adults
Seniors

Fees

Please check the boxes that indicate your fee range.

$ (50-80)
$$ (80-120)
$$$ (120-160)
$$$$ (160+)
I do not wish to include a fee range on my profile at this time. I understand that by checking this box, my profile will not show up in searches where a prospective client includes a fee range.

Fee Statement

If you wish to add a statement regarding your philosophy about fees, please choose one below or use the "Other" option to draft your own.

[Dr. Covelman's] hourly rate is not fixed; he's open to talking with new clients about their fee options and encourages you to reach out if you'd like to learn more about working with him.
[Dr. Covelman] encourages people considering therapy to reach out to discuss fees if there are any questions about this range.
[Dr. Covelman] is willing to talk with new clients about the potential for a lower hourly rate dependent on that client's income; please reach out by phone or email to have a discussion with him.

Headshot Photo Requirements

•Photo must be more than 500 pixels wide. •Photo must NOT be a selfie. •Therapist must be wearing professional clothing and photographed in front of a neutral background. •The photo must contain the therapist’s head, neck, and shoulders. •The photo should be in focus and taken at close range with a high quality camera or cell phone. •Keep in mind, your photo is your first impression for potential clients. Your goal should be to communicate a friendly and welcoming persona to encourage clients to engage with you.

Accepted file types: jpg, png, Max. file size: 50 MB.

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Staff Therapist Contact and Bio Form