Therapist Application

Full Legal Name

First

Last

Professional Display Name

Email

Website / URL

Phone

Upload a Picture for Your Profile

Drag & Drop Files, Choose Files to Upload

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Preferred Contact Method

Professional Title

Jurisdiction(s) where you are licensed, registered, or authorized to practise

Example: Ontario, Canada / British Columbia, Canada / California, USA

Regulatory College or Professional Association

Example: College of Registered Psychotherapists of Ontario

Registration / Licence Number

Years of Experience

Highest Degree / Education

Are you authorized to provide virtual therapy to clients outside your primary jurisdiction?

If you chose "Yes" or "Case-by-Case", please list the jurisdictions and explain the basis of authorization.

Areas of Professional Training

Professional Liability Insurance

Short Bio

Other Specialties

Other Languages

Client Populations

Therapy Approach

Accepting New Clients?

Fee per Session

Do you write articles or educational content about mental health, psychotherapy, counseling, emotional wellbeing, relationships, stress, anxiety, trauma, grief, or personal growth?

Yes
No
I may be interested in the future

Would you like to share any of your articles for possible publication on MENDSKY? It helps the clients know more about you.

Yes
No
I would like to discuss this later

Preferred Session Duration

Available Hours

Time Zone

Jurisdiction(s) where

Do you provide insurance receipts?

Additional Booking Notes

File Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Please upload your Professional Licence / Registration Certificate, Proof of Education / Degree. Professional Liability Insurance Certificate. Resume / CV, Additional Certificates

Confirmation & Consent

I confirm that the information I provided is accurate and complete.
I confirm that I am responsible for maintaining my professional licence, insurance, and legal ability to provide services.
I understand that submitting this form does not guarantee approval on MENDSKY.
I agree that MENDSKY may use my submitted profile information to create or update my public therapist profile.
I understand that MENDSKY may contact me for verification, missing documents, or profile clarification.
I understand and agree that I am responsible for ensuring that I provide therapy, counseling, psychotherapy, coaching, or any related professional service only in jurisdictions where I am legally, ethically, and professionally permitted to practice. I agree to keep MENDSKY updated if my licence, registration, insurance, professional standing, or jurisdictional authority changes.

Typed Signature

By typing my full name below, I confirm that the information I provided is accurate and complete. I also confirm that I have read, understood, and agree to the statements in this application form. I understand that submitting this form does not guarantee approval on MENDSKY, and that MENDSKY may contact me for verification, missing documents, or clarification.

Date

Therapist Application

MENDSKY

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