Clinical Partner Application

Headstrong Clinical Partner

Qualifying Questions

*Are you fully licensed to practice independently?

*Do you regularly use standardized assessments to track progress?

*Are you trained in and utilize at least one of the following EBPs for PTSD: CPT, EMDR, PE?

*Do you have the availability for 2-3 clients in the first month following onboarding?

*Do you have experience working with military/veterans or first responders?

*What is your practice address?

Street Address

City

State

Zip Code

Basic Information

Ex: MD, PhD, PsyD, LCSW, LMFT, LPC

*Military service

*State License(s)

Select all that apply. Use Ctrl function to make multiple selection

Non-English Languages spoken

Select all that apply. Use Ctrl function to make multiple selection

Application

*How did you hear about Headstrong? Please include whether you have colleagues who are current/prior Headstrong Clinical Partners.

*What draws you to become a Headstrong Clinical Partner?

*Describe your experience working with a military and/or veteran population.

*Describe your clinical orientation.

*List your preferred population(s) including age considerations as well as cultural diversity.

*Do you have populations you do not work with?

*List what evidence-based PTSD therapies you use in your practice.

Select all that apply. Use Ctrl function to make multiple selection

*List your clinical specialties

*Do you work with couples?

*Do you work with substance use?

*Do you do neurofeedback?

*Telehealth

*Describe your clinical practice operations including: practice setting, record keeping approach, and scheduling procedures.

*What are your regular hours of operations?

Upload your CV

Upload CV acceptable file types: MS Doc and PDF

Contact Information

New Form Area

Headstrong Clinical Partner

Qualifying Questions

*Are you fully licensed to practice
independently?

*Do you regularly use standardized assessments to
track progress?

*Are you trained in and utilize at least one of
the following EBPs for PTSD: CPT, EMDR, PE?

*Do you have the availability for 2-3 clients in
the first month following onboarding?

*Do you have experience working with military/veterans
or first responders?

*What is your practice address?

Street Address

City

State

Zip Code

Basic Information

Ex: MD, PhD, PsyD, LCSW, LMFT, LPC

*Military
service

*State
License(s)

Select all that apply. Use Ctrl function to make multiple selection

Non-English
Languages spoken

Select all that apply. Use Ctrl function to make multiple selection

Application

*How did you hear about Headstrong? Please include whether you have colleagues
who are current/prior Headstrong Clinical Partners.

*What draws you to become a Headstrong Clinical
Partner?

*Describe your experience working with a military
and/or veteran population.

*Describe your clinical orientation.

*List your preferred population(s) including age
considerations as well as cultural diversity.

*Do you have populations you do not work with?

*List what evidence-based PTSD therapies you use in your practice.

Select all that apply. Use Ctrl function to make multiple selection

*List your clinical specialties

*Do you work with couples?

*Do you work with substance use?

*Do you do neurofeedback?

*Telehealth

*Describe your clinical practice operations including: practice setting, record keeping approach, and scheduling procedures.

*What are your regular hours of operations?

Upload your CV

Upload CV acceptable file types: MS Doc and PDF

Contact Information