This application is for clinicians (therapists, counselors, psychologists, psychiatrists, social workers), as well as industry leaders, technologists, researchers, legal experts, and similar professionals who would like to join the AI Mental Health Collective.
Click the button below to start.
Question 1 of 22
Name
Question 2 of 22
Today's Date
Question 3 of 22
Your Professional Email
Question 4 of 22
Your Professional Title (e.g., Psychologist, LMFT, MD, LCSW, Founder, Researcher, etc)
Question 5 of 22
City of Residence
Question 6 of 22
State / Region of Residence
Question 7 of 22
Country of Residence
Question 8 of 22
Please share your LinkedIn profile and/or website
Question 9 of 22
What interests you about joining the AI Mental Health Collective?
Question 10 of 22
Are you currently a clinician (actively working with clients in some capacity)?
If not, please describe your experience and/or education relevant to the AI mental health space.
The questions in this section are only for clinicians interested in participating in the Clinician's Circle specialty group within the AI Mental Health Collective.
If you are not a clinician, please answer "N/A" to the questions in this section.
Question 12 of 22
License Number (include all: LPC, MD, LMFT, Psychologist, LCSW, etc.)
Question 13 of 22
State(s) or Country of Licensure
Question 14 of 22
Years in Practice
Question 15 of 22
Current Practice Setting
Private Practice (Solo)
Private Practice (Group)
Community Mental Health
Hospital/Medical Center
School or University Counseling Center
EAP
Other
N/A
Question 16 of 22
Demographic of clients you work with (e.g., adults, couples, children)
Question 17 of 22
Treatment Modalities / Approaches (e.g., psychodynamic, CBT, somatic, etc.)
The remaining questions are for everyone interested in joining the AI Mental Health Collective.
Question 19 of 22
How did you hear about the AI Mental Health Collective?
Question 20 of 22
Any additional comments or questions?
Question 21 of 22
By writing my full name I attest that the information I have provided is true.
Please click the final SUBMIT button to ensure we receive your application.
We will be in touch within the next 1-3 business days.