Counselor Registration Step 1

Marriage Counseling, Family Therapy Directory and Resources

Registration- Vital Information

(Items in bold are required)

Username *required

Login Info

Username and e-mail address will not be visible to the public. The e-mail address you give is where you will receive e-mail from visitors to your profile, so please list one that you check often.

Password * min 6 characters;no spaces

Re-enter Password * should be same

E-mail Address *Incorrect

Practice Information

First Name *Incorrect

Practice Info

If you have a title such as "Dr." Please add it before your name in First Name. Enter the address and phone number that is relevant to your practice, not necessarily your home information.

Last Name *Incorrect

Street Address 1 *Incorrect

Street Address 2

City *required

State *required

Zip Code *required

Does Your Practice have a Name?

Phone Number

Gender *required

Male Female

Practice Details

Average Cost per Session *required

Practice Details

Please remember that all of these details will be searchable by visitors. If you accept only certain insurance plans, check Yes and then provide clarification in your office information in the next step.

Years In Practice *required

Do you Accept Insurance? *required

Yes No

Do You Accept a Sliding Scale? *required

Yes No

Do you provide e-Therapy? *required

Yes No

Languages Spoken, Other than English:

Arabic

Chinese

French

German

Greek

Gujrati

Hebrew

Hindi

Italian

Japanese

Korean

Persian

Polish

Portuguese

Romanian

Russian

Spanish

Swedish

Tagalog (Filipino)

Urdu

Vietnamese

Clicking the button below to proceed with registration is confirmation by you that the information you have entered above is true. FixMyFamily.com will not be held responsible for incorrect information contained in your profile.

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