AskTheInternetTherapist.com Counselors and Medical Staff Affiliates

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Medical and Counseling Affiliates Application Form

Welcome! We are in the process of accepting applications for allied health care associates. We are planning on providing not only quality online mental health counseling, but a complete health services clinic. To accomplish this goal we would like to invite counselors, social workers, psychologists, psychiatrists, and general physicians to join.

The fees are very reasonable and include $175 to join, $100 a year for continued development and 10% of what is made from clients coming from this site.  We will provide credit card payment access and continuing web development. We also include aggressive marketing for the team.

If you are interested in joining please fill out the data sheet. Afterwards, please mail a copy of the signed contract, a jpeg picture, a copy of your resume, your credentials, malpractice insurance information, the mediums and times in which you want to be listed on the site, and a small biography to the address below. You will be notified by mail of your acceptance and at that time the joining fee of $175 should be sent to the same address. At the present time we do not provide an 800 telephone line so if you choose to work in that medium that cost will need to be absorbed by yourself. If you choose to work with the audiovisual medium it is necessary for you to provide the camera, videocard, and microphone. All these are very economical, between $250-$500. After you have signed up and been notified of your acceptance you may enter the provider area and set your time availability.

We look forward to working with you. Also if you would like to link our site to yours feel free to copy the banner below and we would be happy to display yours. Thank you. Jef Gazley, M.S.

Put this banner on your site once you sign up to become a therapist to help advertise your virtual practice! Copy the code below and paste into your HTML code:

First Name
Middle Name
Last Name
Address
Apt# or Box
City
State
Zip
Country
Email
Type of Professional
Highest Academic Degree
Years of experience
Specialty areas
Ethnic Background (optional)
Time availability for sessions
Please mail to us: a copy of your resume, copy of professional certification(s), proof of malpractice insurance, a biographical paragraph, hard and soft copy (via email preferably, after approval) a picture (preferably JPG or GIF formats (via email, after approval) your business phone number, a check or money order for $175.00 US after your application has been approved via e-mail. and what * mediums you can practice in e-mail, chat, telephone, or audio visual to: AskTheInternetTherapist.com 6540 E. Kelton Lane. Scottsdale, AZ.85254	* mediums: They are the different ways a therapist can have a counseling session with a client. Some of our therapists utilize the audio/visual method to interact with clients online (using an online messenger that supports video and audio). Some prefer to utilize a secure chat room environment, which is provided by AskTheInternetTherapist.com. Copy of Contract (word document) Copy f Contract (HTML Page)

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Please note that AskTheInternetTherapist.com was formerly known as internettherapist.com.

AskTheInternetTherapist.com
Jef Gazley, M.S., LMFT, DCC
6540 E. Kelton Ln,
Scottsdale, AZ 85254
1-866--998-0560
jef@asktheinternettherapist.com

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