Applicant submission form

1

Please select one of the following* This field is required.

Clinical Social Worker (LCSW, LICSW, etc.)

Marriage & Therapist (LMFT, LCMFT, LIMFT, etc.

Mental Health Counselor (LMHC, LCMHC, LMHP, LPMHC, etc.)

Professional Counselor (LPC, LPCC, LCPC, etc.)

2

How much time do you intend to spend with Ottavo Health clients?* This field is required.

10-15 hours a week

15 to 20 hours a week

20 to 30 hours a week

More than 30 hours a week

Not sure

3

Where do you currently spend most of your time?* This field is required.

Other online platform like Ottavo Health

Clinic or Hospital

Private practice

Community or counseling in an academic setting

Other clinical setting

Not currently practicing

4

Full Name* This field is required.

First Name

Last Name

5

Email* This field is required.

example@example.com

6

Phone Number* This field is required.

Please enter a valid phone number.

7

State(s) you are presently licensed in* This field is required.

8

Upload Resume

Drag and drop files here

Select files to upload

Max. file size: 10.6MB