Theraplay Practitioner Profile Update

Theraplay Practitioner Profile Update

Please note that information listed here will be published on your profile with the launch of our updated website, scheduled tentatively for the end of January 2020. Thank you for your patience!
Name *
Credentials *
Certification Level *
Highest Theraplay training completed (select all that apply) *

Level One Theraplay and MIM Level Two Theraplay and MIM Group Theraplay Sunshine Circles
Practice/Company Name

Practice/Company Address *

Contact Email *
example@example.com
Business Phone Number
Website (please include https://)
Specialties (please select all that apply) *

ADHD Addiction Adoption Anger Management Antisocial Personality Anxiety Asperger's Syndrome Attachment Autism Behavioral Issues Child or Adolescent Chronic Illness Chronic Impulsivity Coping Skills Depression Developmental Disorders Divorce Domestic Abuse Domestic Violence Dual Diagnosis Eating Disorders Emotional Disturbance Family Conflict Foster Care Grief Intellectual Disability Learning Disabilities Marital and Premarital Obsessive-Compulsive (OCD) Oppositional Defiance Parenting Peer Relationships Pregnancy, Prenatal, Postpartum Racial Identity School Issues Self Esteem Self-Harming Sexual Abuse Sleep or Insomnia Stress Suicidal Ideation Teen Violence Transgender Trauma and PTSD Traumatic Brain Injury
Languages you provide services in (please separate by comma, ex. German, English, Spanish) *
Insurance accepted (type N/A if not applicable, please specify plans/types accepted) *
Should be Empty: