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List Your Practice

Interested in listing your practice on the The Counseling Connection Website? Here's what you get:

All that for only $65 for one year, plus a $50 set-up fee. Print or save this form, fill it out and send it with your check for $115 to:

The Counseling Connection
Deirdre Knowles, MA
6000 Southcenter Blvd., Suite 16
Tukwila, WA 98188

Or save $20 off the set-up fee and get faster service: Email the form to: dknowles@counselingconnect.com
(You still have to send the check via snail mail, but it's only$95!)

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THE COUNSELING CONNECTION

Listing Information - Please fill in blanks, and DELETE what DOES NOT apply to you.  

Name:
Address:
City, ST, ZIP:
Phone, Fax #:
Email:
Web site:
~~~~~~~~Billing information~~~~~~~~~~For TCC records only~~~~~~~~~~
Billing Address:
City, ST  ZIP:
Phone, fax#:
License/Certification/Registration #, or other credential:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Short phrase that describes your practice:

Education:   BA  MS   MSW   PhD   PsyD   M.D.   RN

Licensed:   Psychologist   Psychiatrist   LMFT   LMHC   LCSW

Registered:	
Other:   QCDC   RN   ARNP   ATR	

Work with:   Individuals  Couples  Families  Children
In practice since:     Sliding scale, payment arrangements or similar device? Describe:

You may add additional info here if you wish, or send a separate file.

APPROACHES:
Biofeedback
Cognitive-Behavioral
Family of Origin
Systems
PsychoSynthesis
12-Step
Hypnosis
Ericksonian Hypnosis
Object Relations
Guided Imagery
EMDR
Play Therapy
Brief, Solution-Focused
TA
Relaxation
Art/Movement

ISSUES: Please DELETE the situations or issues you DO NOT work with.  
Feel free to add any that better describe to the general public what you do.

Abortion Counseling
Abuse(Physical / Emotional / Sexual)
Addiction
ADD / ADHD
Adolescents / Teens
Adoption
African American Issues
Aging
Anger, Anger Management
Anxiety
AIDS-HIV Positive Issues
Asian American Issues
Bipolar Disorder
Blended Families
Borderline Personality Disorders
Business Organizational Development
Career Counseling
Chemical Dependency Treatment
Children
Chronic Physical Illness
Clinical Supervision
Co-Dependency / Adult Children / ACOA
Conflict Resolution
Communication Skills
Couples Therapy
Court-approved-DV, Anger, Sex offense, Alcohol
Creativity Issues
Crime Victims
Cult Debriefing
Custody Evaluations
Death & Dying
Depression
Developmental Disabilities
Diet & Nurtrition Counseling
Divorce / Custody Negotiation
Domestic Violence (DV)
Drug Abuse
Eating Disorders
Family of Origin Issues
Family Therapy
Feminist / Women's Issues
Fertility Counseling
Finances
Forensic Psychology
Geriatric Issues
Grief & Loss
Hispanic / American Issues
Incest
Inter-racial marriage and family issues
Interventions
Intimacy Issues
Learning / Behavioral Disabilities
Life Transition
Medication Management
Mediation
Menopause
Men's Issues
Mood Disorders
Multiple Personality Disorders
Native American Issues
Non English Speaking Groups
Non Western European Cultural Groups
Obsessive / Compulsive Disorder(OCD)
Panic Attacks
Parenting Issues
Partners of Incest / Trauma Survivors
Personal Motivation / Goal Setting
Pregnancy Counseling
Pre-Marital / Marriage Preparation
Prescriptive Authority
Psychological Evaluations
Physically Challenged Individuals
Phobias
Post Traumatic Stress Syndrome
Rape / Assault / Violence Issues
Recovery Issues
Relationship Issues
Religion-Based (Which?_)
Religious Abuse
Remarriage
Ritual Abuse
Schizophrenia
Seasonal Affective Disorder
Self Harm
Self Esteem Issues
Sex Role Issues
Sexual Dysfunction
Sexual Orientation
Single Adult Issues
Smoking
Spirituality Issues
Sports Psychology
Stepfamilies
Stress
Terminal Illness
Weight Loss

Send questions or comments to: dknowles@counselingconnect.com