Clinical Profile Questionnaire
Share your professional approach, ideal client preferences, and what potential clients should know about working with you.
Name
First Name
Last Name
What type of clients do you feel most passionate about working with?
*
What concerns or challenges do you feel most confident treating?
*
What therapeutic approaches or interventions do you commonly use? (Select all that apply or describe others below)
*
Cognitive Behavioral Therapy (CBT)
Dialectical Behavior Therapy (DBT)
Acceptance and Commitment Therapy (ACT)
Psychodynamic Therapy
Solution-Focused Brief Therapy
Family Systems Therapy
Motivational Interviewing
Other
If you selected 'Other' or wish to further describe your therapeutic approach, please provide details here.
How would you describe your counseling style?
*
What would you like potential clients to know about you before scheduling their first appointment?
*
Are there any client populations or clinical concerns that you do not feel comfortable treating currently?
*
Imagine a client is reading your profile because they're nervous about starting therapy. In 3–5 sentences, what would you want to say directly to them?
*
A few details for your bio" section
This info will be use to create your bio for the website.
Education
*
Your degrees and where you earned them (for example, Master's in Mental Health Counseling, Fordham University)
Licensure
*
Which states are you licensed in, and what is your license type?
Years of clinical experience
*
What do you provide?
*
If you provide evaluations, which types?
Assessment tools you use
If you conduct evaluations, list the tools you're trained in (for example, ADOS-2, ADI-R, MBMD). Leave blank if not applicable.
Areas of expertise
List your main specialties as you'd like them shown (for example, anxiety, trauma, grief, life transitions).
Languages
What languages do you provide services in?
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