Therapist Inquiry
If you are a Mental Health Professional seeking info on our Inspiring Hope Project, fill out the form below and we will respond within one week. This project aims to provide therapy assistance directly to Mental Health Professionals for residents of South Dakota that are experiencing financial hardship and are in need of Behavioral Health Care. This assistance is intended for providers in private practice.
Therapy Business Name
*
Therapist/Counselor
*
First Name
Last Name
Email Address
*
example@example.com
Logo Upload
*
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By providing your logo, you agree to LI365 adding it to our website to help promote your practice.
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of
Website
*
Therapist Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
I can confirm I am a provider in South Dakota.
*
Yes
No
How did you hear about this project?
*
Please Select
LI365 website
The 437 Project
Therapist
Client
Social Media
OTHER
Have you partnered with or supported Live Inspired 365? If so, please explain:
*
Reason for Inquiry:
*
Notes
Please provide any other information you want us to know
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