Clinician Application | PsyCare+

Personal Information

Let's start with your basic contact details.

First Name *

Last Name *

Email Address *

Phone Number *

City *

State *

LinkedIn Profile URL Optional, but helpful for learning more about your background

Professional Credentials

Tell us about your licensure and educational background.

License Type *

License Number *

State(s) Licensed * Separate multiple states with commas

License Expiration Date *

NPI Number * 10-digit National Provider Identifier

Years of Clinical Experience *

Educational Background

Where did you complete your graduate training?

Graduate School/University *

Degree Earned *

Additional Certifications

Practice Details

Help us understand your current practice setup.

Current Practice Situation *

Solo Private Practice Group Practice Agency/Organization Starting New Practice

Practice Name

Practice Website

Service Delivery *

Telehealth In-Person Hybrid (Both)

Current Payment Model *

Private Pay / Self-Pay In-Network Insurance Out-of-Network Sliding Scale

Current Session Rate Range

Current Caseload (clients/week)

Specialties & Populations

Tell us about your clinical focus areas and expertise.

Age Groups Served *

Children (0-12) Adolescents (13-17) Young Adults (18-25) Adults (26-64) Seniors (65+)

Do you offer psychological testing/assessments?

Yes No

Availability & Preferences

Let us know your capacity and what you're looking for.

How many new clients can you take on? *

1-5 per month 5-10 per month 10-15 per month 15+ per month

Typical Availability *

Mornings (8am-12pm) Afternoons (12pm-5pm) Evenings (5pm-9pm) Weekends

What services interest you most from PsyCare+? *

Patient Referrals Insurance Billing Support Marketing & Visibility Administrative Support Credentialing Assistance Professional Community

How did you hear about PsyCare+?

What are your biggest practice challenges right now?

Anything else you'd like us to know?

Review & Submit

Please review your information before submitting.

Upload Documents (Optional)

You can upload your CV/resume and a copy of your license for faster processing.

CV / Resume

Click to upload CV (PDF, DOC)

License Copy

Click to upload License (PDF, JPG, PNG)

Agreements

Please confirm the following before submitting.

I confirm that all information provided is accurate and complete. *

I consent to PsyCare+ contacting me about partnership opportunities. *

I confirm that my license is in good standing with no disciplinary actions. *

Application Submitted!

Thank you for your interest in joining PsyCare+. Our team will review your application and reach out within 3-5 business days.

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