Proven Pathways Therapist Interest Form
Thank you for your interest in joining the Proven Pathways team! Please complete the following form, including a PDF of your updated CV, to apply as a therapist.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please describe your licensure in the state of Ohio. What type of license do you have and how long have you had the license? If you are in the process of applying for independent licensure in Ohio, please describe where you are in the process.
Have you ever been subject to disciplinary measures by a professional regulatory board, experienced revocation or suspension of your professional license, or been the subject of a formal complaint in relation to your practice as a psychotherapist?
Yes
No
Please indicate any and all age ranges of the client populations with which you work (select all that apply):
Adolescents (13-17)
Adults (18-64)
Older adults (65 plus)
Please select which kinds of mental health conditions/concerns you have experience/comfort in treating:
Depressive disorders
Generalized anxiety
Social anxiety
Panic Disorder/Agoraphobia
Illness anxiety/somatic symptom disorders
Grief
ADHD
Chronic pain
Couples issues (with couples therapy)
Bipolar disorders
Borderline personality disorder
Suicidal ideation
Eating disorders
OCD
Skin-picking (Excoriation)
Hair-pulling (Trichotillomania)
Insomnia
Other
What other conditions do you have experience/comfort with treating? If the list above includes all conditions you treat, you can also indicate what, if any, special populations you have experience with treating, including Veterans, LGBTQ+, perinatal population, etc.
What types of evidence-based psychotherapies do you have training in/experience with providing? What would you say are your predominant therapy orientations you work from?
How often do you incorporate between-session skills practice (i.e., "homework") into your treatments?
How often do you incorporate measurement-based care (i.e., having clients complete measures during treatment, like the PHQ-9 or GAD-7, and incorporating this into regular discussions of treatment progress) into your treatments?
Are you comfortable with and experienced in providing telehealth services?
Yes, I am both comfortable and experienced
I am comfortable but lack experience
I am experienced though notably prefer in person
I am neither comfortable or experienced
Have you thought about your preferred average client hours a week? Please give a range.
What appeals to you about our practice? Why do you think you might like working here?
Please upload a copy of your CV in PDF format.
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