Outro Provider Interest Form

Outro Provider Interest

If you are a healthcare provider interested in working with our team, please complete this form.
Full Name:

First NameLast Name
Email Address:
example@example.com
Phone Number:
Format: (000) 000-0000.
Current Location:

Street Address

Street Address Line 2

CityState

Zip Code
LinkedIn URL:
What state(s) are you licensed in? Please select all that apply.
Provider Type:
If Other, please specify:
In what capacity would you like to work with us?
If Other, please specify:
Do you have a compact license?
Do you have a DEA license?
What state(s) do you have an active DEA license?
Please provide additional licenses that are relavent to the capacity in which you would like to work with us?
Example of additional licenses: yoga, functional medicine, nutrition, physical therapy, etc.,
Please indicate which platforms you are currently credentialed with:
If Other, please specify:
Do you have any experience with the following? Please select all that apply:
Please provide examples from the previous question!

How would you describe yourself in and out of the workplace?

Rows	Most of the time	Sometimes	Not often
I take initiative to support my team.
I am open to learning new skills and improving on the status quo.
I am organized and/or detail-oriented.
I'm able to express both concerns and positive feedback to the whole team.

What draws you to Outro?
What is your clinical philosophy?
Describe your understanding of deprescribing and/or hyperbolic tapering. Please write this answer in your own words!
Personal experience with the hyperbolic tapering approach is NOT necessary.
Do you actively prescribe or manage antidepressants or other psychiatric medications?
Have you tapered antidepressants before? If so, can you tell me an example?
Have you ever seen a patient struggle with medication withdrawal or discontinuation. What happened and how did you respond?
Some clinicians prescribe SSRIs for indefinite use, while others believe they should be used for the shortest effective duration. Where do you stand, and how does it impact your clinical approach?
Can you share a time when you advocated for a patient’s needs that differed from the standard treatment plan? What was the situation and outcome?
This is not a required field for the application.
Do you have experience working with a broader care team (therapists, GPs, specialists, health coaches, etc)? What was your role in that collaboration?
This is not a required field for the application.
Are there any clinical practices in psychiatry today that you question or disagree with? Please share your thoughts.
This is not a required field for the application.
Do you have any subspecialties or areas of clinical interest?
This is not a required field for the application.
Have you attended our live webinars or watched the recordings on YouTube?
What is your current work schedule?

Other
What’s your ideal start date?
Upload Your Resume/CV

Cancelof
Did we miss anything?
Feel free to leave any final thoughts, open questions, or feedback on the application form.
Should be Empty: