Become a GTIP Associate

Become a GTIP Associate

We encourage you to complete all sections, but some sections are not required.
Name

First NameLast Name
Pronouns
Degree/ Credentials
Client Focus
If you selected "Other" above, please specify:
Therapy Philosophy? (200 words or less) (Optional)

0/200
Office Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Professional Website
Link to Psychology Today profile:
Business Email
example@example.com
Business Phone
Offering Virtual Sessions?
Accepting New Clients?
Fee Range
Sliding Scale?
Insurances Accepted (please specify, ex. BCBS, ComPsych, Keystone, etc.)
Social Location identities you'd like to share: gender, race, sexual orientation, age, religion, nationality, citizenship status, language(s) spoken, etc.)
Please upload a headshot:

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Please select to pay
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Associate Dues
Annual Associate Dues of $150 go directly to supporting GTIP’s programming and scholarships and are a wonderful way to stay involved in our community and connect with individuals looking for a Gestalt practitioner.

$150

Total

$0.00

Debit or Credit Card

Choose from one of the PayPal options to make your payment.