Practitioner Profile

New Provider Application

Please complete the following form to submit your SoulBeing application. This information will be reviewed by our team and serve as your Provider Profile and your personalized booking pages.
Name *

First Name Last Name
Business Name
Phone Number *

Area Code Phone Number
Business Email *
Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Business Overview *
Please provide a brief description of your business and services.
Business Biography *
Please describe your experience including licensure, credentials, certifications, etc.
Modality *

Acupuncture Breast Reconstruction Chiropractic Care Christian Science Counseling Dancing Lessons Dental Care (non cosmetic) Dermatology Treatments and Products Doula/ Midwife or Birthing Coach Dyslexia Treatment Fertility Treatment Fitness/Yoga Functional Medicine Guide Dog Healthcare Professional Home Improvements Infertility Treatments Integrative Medicine Learning Disability Treatments Long-Term Care Massage Therapy Medical Equipment Repairs Naturopath Nursing Services Nutrition and Diet OB-GYN Optometrist/Ophthalmologist Orthodontia Osteopath Physical Therapy Physician (other) Physician/ Nurse/ Healthcare/Other Prosthetics Psychology/ Therapy Specialized Education Speech Therapy Traditional Chinese Medicine
Areas of Specialty: *

Alternative Healers Alzheimers Back Pain Certified Health Coach Children Children's Yoga Coaching Couples Deep Tissue Dementia Developmental Disabilities Diabetes Diagnostics Services Eating Disorders Exploring and Dissolving Emotional Blocks Family
Conditions Treated *

Abdominal Pain Alcohol Use, Abuse and Dependence Anxiety/ Panic Attacks Asthma/ Breathing Issues Back Pain Blood Pressure Child/ Adolescent Behavioral Chronic Condition (other) Chronic Nausea or Vomiting Dental Issues Depression Digestive Issues Earache Eating Disorder Eye Condition or Pain Fatigue/ Weakness Fertility Issues Headaches Hearing Issues or Loss Insomnia Men's Health Issues Obesity/Overweight Other Pain/Joint or MSK Paranoia PTSD Skin Condition or Irritation Smoking/ Tobacco Use Substance Abuse and Dependence Vision Loss or Change Women's Health Issues
Scheduling Availability *
*Please indicate availability for both in-person and virtual appointments.
Your Services
As a Soul Being provider, you can list your services on your personalized booking page. Please fill out the table below with all of the services that you wish to have displayed on your page. Make sure to include:
- The appointment name will be the name of the service or product (i.e. "General Consultation")
- A description of the service (i.e. "An initial assessment to getting to know your health profile and your background")
- A duration (in minutes)
- A price (in dollars)
- A buffer (the amount of time you need after a session to prepare for your next meeting)
- A type (does this need to be a phone, video, or messaging appointment)
Without these details, we will create generic appointment types for you that will be listed as 30-minute, 60-minute, and 90-minute consultations
Example
Please see the below image for an example of a service offered:
Your Services:
As a SoulBeing Provider, you list your services on your personalized booking page. Please fill out the table below with all services that you wish to have displayed on your page. Please include:

	Appointment Name	Description	Duration	Price	Type (video or phone)
Service A
Service B
Service C
Service D
Service E

Appointment Cancellation fee (Optional)
Appointment Cancellation threshold in hours (Optional)
How many hours in advance should a customer be able to request an appointment with you?

0 hours 24 hours 48 hours
Would you like to manually accept the appointment request before they get scheduled in your calendar?

Yes No
Activate Your Stripe Connect Account (Required for billing)
SoulBeing uses Stripe to help facilitate payments directly to you. You must create a Stripe Connect account if you plan to charge clients for your services through the SoulBeing platform. Please make sure that you complete the Stripe Connect setup process BEFORE you submit this form.

Click Here to Activate Your Stripe Account
Accounting Email (Optional)
When provided, appointment receipts will be sent to this email
Upload Credentials *

Browse Files
Please upload licensure or certification. Cancel of
Headshot or Logo *

Browse Files

Cancel of
Community Guidelines By joining this community, you agree to uphold our values as stated below:
1. Integrity: Be honest and direct in all your activities and communications. Maintain transparency with your clients about pricing and what takes place during treatments/sessions.
2. Gratitude: Be grateful for your clients. Always treat them with the same respect and appreciation you wish to receive. It is a privilege to practice all forms of care.
3. Confidentiality: Clients have their right to privacy. Never disclose personal information about a client without their written consent.
4. Refer: You are an ambassador for all wellness professionals. Recognize when there may be a therapy or other practitioner that may be a better fit for your client. Acknowledge that different therapies work in conjunction with one another for the whole health of a client. If you’re not having success with someone, encourage them to explore alternatives. Get them the help they need, even if that is not with you.
5. Accountability: It is your responsibility to provide clients with relevant information and quality care. Hold yourself to high ethical standards personally and professionally. Abstain from use of drugs or alcohol during all professional activities. Maintain all necessary licenses, certifications and insurance required to perform any services for a client.
6. Trust: Be trustworthy. Deal fairly and equitably with your clients and other wellness professionals. Do not diagnose a client unless you are qualified to do so.
7. Listen: Be present with your clients. Give them your undivided attention. Do not interrupt them, do not rush them, and do not assume. Admit what you do not know.
8. Follow Up: Do what you say you are going to do. Check in with your clients periodically. Cultivate a continuous relationship.
9. Compassion: Practice empathy. Be considerate and caring.
10. Freedom: Accept that you are a facilitator. You can educate, encourage, and guide, but you cannot make decisions for your clients. What they choose do is up to them. Their healing and health is ultimately their responsibility.
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New Provider Application