Application for Associate Role

I confirm I am a qualified counsellor/psychotherapist/psychologist

I confirm I am registered with a professional body associated with the Professional Standards Authority

I confirm that I receive regular supervision as required by my professional membership body.

Your contact details

Your first and last names

What are your pronouns? (optional)

Email

Confirm email

Mobile number

Location

Tell us about you as a therapist

Which counselling professional membership body are you registered with?

Please provide your membership number

Year qualified

What therapeutic modality or approach do you primarily use?

If you have a website, please provide the link here.

If you have a directory profile, please provide the link here.

What are your main areas of therapeutic work or specialisms? We ask so we can connect you with someone you are especially well suited to help.

If you are applying as a Couples Therapist, what training or experience do you have in couples therapy?

Are there particular areas you especially enjoy working with?

Are there any areas of work you prefer not to take on?

(Optional) Do you identify as LGBTQ+, ADHD, autistic, or AuDHD? We ask because it can be important to some clients that they work with someone who shares aspects of their lived experience.

(Optional) How do you describe your gender? (We ask because some clients have a preference).

What experience or training do you have in working with neurodivergent clients?

Your availability

What days/times are you available for new clients? (You can tick more than one.)

Approximately how many clients per week would you like to take on?

If there is anything else you would like us to know about you, you can use this space here.

Please attach a copy of your CV

Please attach a copy of your qualification certificate/s.

Please attach a copy of your certificate of professional body membership.

Please attach a copy of your current certificate of insurance.

When you press Submit, your form will be sent to us and we will be in touch within a couple of days. If you don't here from us, please feel free to get in touch by email anne@annelewistherapy.co.uk.

VIVA Therapy

Online Therapy, wherever you are

Application for Associate Role

Your contact details

Tell us about you as a therapist

Your availability

What days/times are you available for new clients? (You can tick more than one.)