2023 Theraplay Practitioner Profile Update

Theraplay Practitioner Profile Update

Please note that information listed here will be published on your practitioner profile on the TTI website directory.
If I am located in the UK or Australia, I consent for my information to be listed on my local affiliate's directory.

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I am currently accepting new clients.

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Name*
Credentials*
Certification Level (select all that apply)*

Foundational PractitionerIntermediate PractitionerFully CertifiedFoundational Group PractitionerCertified Group PractitionerCertified SupervisorCertified Trainer
Highest Theraplay training completed (select all that apply)*

Level One or Theraplay Modules 1-6Level Two Theraplay and MIMGroup TheraplaySunshine CirclesOther
Practice/Company Name
Practice/Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Region*
Ex. Essex, Worcestershire, Birmingham
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)*
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