Directory Submission Form


Community members contact us regularly asking for names of professionals to assist them with their mental and behavioral health issues.  To answer that need, we have created a comprehensive list of providers to whom we can refer people when they contact us.  Please take 5 minutes to give us your information and please pass along to your colleagues!

 

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*What type of Provider are you?:
*Which best describes your primary location in Palm Beach County?:
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Or you may complete a separate form for each location.
*Are you licensed?:
*Is your organization accredited?:
*Please check the boxes next to the populations you serve (check all that apply).:
*Please check all of your areas of specialization.:
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*Please check the box next to all forms of insurance/payment you accept::
*Will you see clients on a sliding scale?:
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*Can we refer people to you who may not have health insurance?:
*Will you see clients on a pro bono basis?:
*I do not wish to have my professional information included in your online resource directory.:
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*Have you had training to work with veterans and their families?:

Providers