Member Details Update 2026 Name(Required) First Last Resident Town/City(Required)Resident State/Region(Required)Resident Country(Required)Email(Required) For membership-related emails, newsletters, and receiptsWebsite(Required) Have you ever logged in to our community website?(Required)NoYes, but I use it infrequentlyYes, and I use it oftenWhat is this?This is the discussion board. Webinar recordings are also posted here.Do you want to receive referrals from us?(Required)Yes, and it's OK to share my contact info with potential clientsYes, but I DON'T want my contact info shared. Please send me potential client info and I will reach out to themAny additional notes on what kind of referrals you prefer?Licensed States/Regions(Required)We assume you are licensed in your state/region of residence. Please let us know if you are also licensed in other areas.Are you PSYPACT certified? Yes Any details on your training/education that will help us better understand your specialties?Preferred Contact Email for Referrals / New Patients If different from your primary membership email as stated aboveDo you work in-person, virtually, or both?(Required)In-PersonVirtuallyBothClinical Focus(Required) Children Adolescents Young Adults Adults Detransition Parent Support Family Therapy Do you currently work with gender distressed patients?(Required)NoYesDo you only work with males or females?Either is fineOnly malesOnly femalesAny other notes describing your practice, or areas of specialty?
