Screening for PMADS Medical Provider Training Registration Form

Screening for Perinatal Mood & Anxiety Disorders (PMADs)

for Reproductive & Medical Providers ONLY
ON-DEMAND COURSE WEBINAR
What's included in this FREE on-demand webinar course:
🩺 Defining Perinatal Mood and Anxiety Disorders

🩺 The prevalence & risk factors of PMADs

🩺 PMAD higher levels of care

🩺 PMAD screening, treatment, education & best practices

🩺 Local and national PMAD resources and referrals

Easy to access, time-efficient course layout

Thorough and comprehensive

Resources + EPDS link
This on-demand webinar course is created and presented by Heena Khan, LPC-S, RPT-S™, PMH-C, CYT

Perinatal Mental Health Clinician | Founder & Clinical Director at Bloom Center for Motherhood
Name*

First NameLast Name
E-mail*
example@example.com
The name and location of your clinic*
MD/OBGYNMidwife/DoulaNP/PMHNPRNPALactation ConsultantMedical Assistant
I understand this webinar course is for reproductive/medical providers only, I'm not a licensed mental health counselor
FB GroupTherapist friend/ColleagueWebsiteInstagramHeather Sorenson, our Community Relations Specialist
All moms gets screened at least onceAll moms get screened every trimesterWe need help with determining the screening scheduleWe don't Screen at this time, but would like to start implementing this asap
Not very often (once or twice a year)Somewhat often (every 2-3 months)Quite often (almost every month)Regularly (a few Moms every month)
A live, scheduled webinar with your team during lunch hourAccess to an on-demand webinar that your team can access according to their own schedule
Stigma/ShameThey don't know where to startMaternity LeaveFinancial barriersChildcare troubleOther
OPTIONAL : This on-demand course is FREE for all medical providers and staff, however, many providers in the community have requested an opportunity to contribute to a fund in lieu of a complimentary training. Should you choose to support us in this way, a portion of your contribution will support our operations in creating this course and a portion of it will be added to our Bloom Scholarship Fund - this fund will provide partial financial support for Moms that are seeking services/programs at The Bloom Center for Motherhood and currently experiencing financial hardship.

Your contribution is completely optional and does not impact our professional relationship, partnership and support in any way.
If you would like to contribute please enter the amount below, otherwise skip this section and click the Submit button at the bottom of this form.

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Upon submitting this form, you will recieve an email with the next steps to access your on-demand webinar.

If you experience any technical troubles, please email us: contact@bloomcenterformotherhood.com
By submitting this form, you agree to receive emails from The Bloom Center for Motherhood.
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Screening for Perinatal Mood & Anxiety Disorders (PMADs)

ON-DEMAND COURSE WEBINAR

What's included in this FREE on-demand webinar course:

This on-demand webinar course is created and presented by Heena Khan, LPC-S, RPT-S™, PMH-C, CYT