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 MIMLevel Two Theraplay and MIMGroup TheraplaySunshine CirclesOther
Practice/Company Name
Practice/Company Address*

Street Address

Street Address Line 2

CityState / Province

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

ADHDAddictionAdoptionAnger ManagementAntisocial PersonalityAnxietyAsperger's SyndromeAttachmentAutismBehavioral IssuesChild or AdolescentChronic IllnessChronic ImpulsivityCoping SkillsDepressionDevelopmental DisordersDivorceDomestic AbuseDomestic ViolenceDual DiagnosisEating DisordersEmotional DisturbanceFamily ConflictFoster CareGriefIntellectual DisabilityLearning DisabilitiesMarital and PremaritalObsessive-Compulsive (OCD)Oppositional DefianceParentingPeer RelationshipsPregnancy, Prenatal, PostpartumRacial IdentitySchool IssuesSelf EsteemSelf-HarmingSexual AbuseSleep or InsomniaStressSuicidal IdeationTeen ViolenceTransgenderTrauma and PTSDTraumatic Brain InjuryOther
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: