Request a Profile - Therapist Directory PSCSW

Request Profile

Use this form to request profile be created on the directory. A staff member of PSCSW will review your request and check it against Active Membership. Once your Profile Request has been Accepted a representative will reach out to you via the preferred email address you provided. *Before you start! Scan the form and make sure you have all the required information (pictures, description, ect). We can make adjustments later but it will help the process if you have as much info as possible before submitting, the first time.

First Name(Required)

Last Name(Required)

Certificates, Certifications and Licenses(Required)

Seperate with a comma (example: Certificates, Certifications and Licenses)

Preferred Pronouns(Required)

Please list with slash (example: she/her)

Email Public(Required)

Public email that will be used on your profile.

Email Private (if different)

This is the email our team will use to contact you. If you leave this blank we will use the Public Email.

Phone (public)(Required)

Phone number to use on your profile

Phone (private)

Phone number our team will use to contact you, if different from public. This will not be listed on your profile.

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Profile Picture (Upload)(Required)

Accepted file types: jpg, png, Max. file size: 15 MB.

Please upload a profile picture, picture should be a standard square headshot, ideal minimum size is 300x300px

Excerpt Description(Required)

There is your shortened listing, for searches, and your Profile. This is the shortened text that will appear under you name and basic information. This is the teaser content that will convince people to click on your profile. 100 words or less.

Overview Description(Required)

This section is your introduction for new clients looking for services. It should be around 300 to 1000 words in length.

Specialties and Expertise(Required)

Please limit yourself to 4 primary specialties or expertise. If you would like to list more, because they are important to your business, list them separately (example: top 4: | others: )

Treatment Approach(Required)

Please list the types of therapy you offer, this should be a list of titles seperated by commas (example: Cognitive Behavioral (CBT), Compassion Focused, Culturally Sensitive)

Fees(Required)

Please submit what your fee structure is and how much. Also list out which types of payments you accept.

Insurance Accepted(Required)

Please list out what kind of insurance you accept, if any.

Primary Website URL

This is the primary website URL for your Profile.

Social Media LInks and Other Websites

Please provide the links to all the social media profiles and additional websites you would like to have appear on your profile. (Example: https://www.facebook.com/thepscsw)

Future Interest: Enhanced Profile(Required)

Would you be interested in hearing more about a future upgrade option called Enhanced Profile. Although not yet available, we plan on rolling out a completely customizable profile upgrade. Move your sections around, add sections, add more copy, multimedia options, a truly catered experience.

Yes

Phone

This field is for validation purposes and should be left unchanged.

Request Profile

Pennsylvania Society for Clinical Social Work

Pennsylvania Society for
Clinical Social Work