Name *

First Name

Last Name

Are you fully licensed the state of Maryland? *

Yes

No

Our practice specializes in the treatment of children, adolescents and young adults. Do you have training in child psychology? *

Yes

No

Are you available to work (see clients) at least 15 hours per week? *

Yes

No

Do you have previous private practice experience? *

Yes

No

Our clinicians focus on helping the community by way of marketing, networking and providing community speaking engagements. Are you comfortable with this responsibility? *

Yes

No

Our clinicians are able to work independently and follow directions easily. Do you feel comfortable working independently and being able to follow through on scheduling clients, collecting payment, keeping notes accurate and timely, responding to emails in a timely fashion, and staying organized? *

Yes

No