CBT-I Directory Website Registration

CBT-I Directory Registration

Thank you for your interest in requesting clinician access to the CBT-I International Directory. Please complete the fields below. We will evaluate your qualifications and information and contact you if you meet our criteria.
Clinician Contact Information
Name*

First NameLast Name
Phone Number*

Country CodeArea CodePhone Number
Email*
example@example.com
Please verify your Email*
example@example.com
Clinician Practice Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
About Your CBT-I Experience
Do you have certifications and/or training in CBT-I*

YesNo
Please provide a few details on your CBT-I qualifications and training.*
Help us maintain the integrity of the directory and filter out fake account creations.
Please provide some information about your practice*

I provide services from a clinician office onlyI provide telemedicine services onlyI provide office based and telemedicine servicesUnsure at this point
Your CBT-I Directory Details
How can we help you?*

I'm seeking new patients for my practice.I'm seeking peer supervision and consulting work.
Do you give your permission to share your directory information with the Society of Behavioral Sleep Medicine (SBSM)?*

YesNo
Additional Questions
How did you hear about the CBT-I International Directory?*
Next Steps

After hitting the submit button below your information will be provided to the website administrator to vet your application. After your information is verified you will be contacted with login information to access your directory listing. Expect an email within one business day.
Should be Empty:

CBT-I Directory Registration

Clinician Contact Information

About Your CBT-I Experience

Your CBT-I Directory Details

Additional Questions