Therapist Intern Onboarding Form All of the Following Must be Okay with your Program Requirements: * (ALL MUST BE CHECKED IN ORDER TO MOVE FORWARD) Virtual Therapy is Okay with my Program I Can be Supervised by an LICSW with 5 years experience Weekly Group Supervision Meets my Program Requirements I Can be Supervised by a Massachusetts LICSW Supervisor Name * First Name Last Name Email * This is where eTherapyCare corporate communications will go. You will be provided an @etherapycare email address as well. Phone * (###) ### #### Preferred Start Date MM DD YYYY Home Address * For Corporate Info only, only state will be shared publicly. Address 1 Address 2 City State/Province Zip/Postal Code Country Supervision Requirements * What type of supervision does your program require? What are your standing hours of availablility? * You're in control of your schedule. Clients prefer regular recurring session times. We will build your available schedule off of the schedule provided here. Keep in mind sessions run in 50-min blocks. Schedule Preference * Do you prefer to run sessions back-to-back or you prefer a break in-between? Run Sessions Back-to-Back (except lunch) I prefer a 10-min break in-between sessions Other (include instructions in message box below) All States You Want to See Clients From? * I have malpractice insurance. * Yes No Marketing Bio & Areas of Interest * Here, outline your education, experience, areas of interest when working with clients... what's unique about working with you? Credentials * List your credentials as you'd like them to be publicly represented All States Where Licensed & License Number: Therapeutic Approach Ideal Client * What type of client do you enjoy working with? Clients not interested in working with... * What type of clients are you not interested in working with? Other Thank you! We’ll be in touch shortly!
