Registration Form ( Expert )

Your name

Name of Clinic/ Organization*

Your email

Address Line 1 - House/Plot No

Address Line 2 - House/Plot No

Address Line 3 - House/Plot No

City

Phone Number

website

Qualification

Specialized Training (If Any)

RCI Registration

Awards or Publications

Short Bio (min 100 words)

Years of Practice

Populations you work with*
ChildrenAdolescentsAdultsOlder AdultsOther:
Type of Psychologist (Eg: Clinical Psychologist, Counselling Psychologist, etc)

Psychiatric Issues
ADHD/ADDAddictionAnorexia NervosaAnxiety DisordersAsperger's SyndromeAutism/ ASDBipolar DisorderBulimia NervosaBody dysmorphic disorder (BDD)Borderline personality disorder (BPD)Child DevelopmentChronic PainDementiaDepressionDissociation and dissociative disordersDrug AbuseDysthymiaEating DisordersHypomania and maniaLearning DisabilitiesNeurological DisordersNeurodevelopmental Disorders (ADHD, Cerebral Palsy, Learning Disabilites, etc)Neurodegenerative Disorders (Alzheimer's Disease, Parkinson's Disease, etc)Mood DisordersObsessive Compulsive Disorder (OCD)Panic AttacksPersonality disordersPhobiasPostpartum DepressionPerinatal Mental HealthPremenstrual dysphoric disorder (PMDD)PsychosisSchizoaffective disorderSchizophreniaSexual DisordersSleep DisordersStressSuicidal IdeationTardive dyskinesiaTraumaOther:
Psychological Issues
AbandonmentAbortion or Post Abortion IssuesAbuse or Abuse Survivor IssuesAcademic ConcernsAdjusting to Change or Life TransitionsAdoption or Reunion IssuesAging and Geriatric IssuesAngerAttachment IssuesBody ImageBreakupBullyingCareer ChoiceCaregiver Issues or StressChild and/or Adolescent IssuesChronic Illness or DisabilityCodependency or DependencyCommunication ProblemsDivorce or Divorce AdjustmentDomestic ViolenceEmotional AbuseEmotional IntelligenceEmptinessFamily ProblemsFearFertility IssuesForgivenessGamblingGrief, Loss, and BereavementHabitsHIV or AIDSHoardingIdentity IssuesInfidelity or Affair RecoveryJealousyLGBTQAI (Lesbian, Gay, Bisexual, and Transgender) IssuesLonelinessMidlife Crisis or Midlife TransitionOppositional and Defiant Behavior in Children and TeenParentingPeer PressurePerfectionismPre-Marital IssuesRelationships and MarriageSelf ActualizationSelf CareSelf CompassionSelf ConfidenceSelf DoubtSelf EsteemSelf HarmSexual AbuseWomen's IssuesWorkplace IssuesWorryWorthlessnessYoung Adult IssuesOther:
Psychological/ Therapy services you provide
Acceptance and Commitment Therapy (ACT)Anger ManagementAnimal-Assisted TherapyApplied Behavior Analysis (ABA)Art TherapyAttachment-Based TherapyBibliotherapyBiofeedbackBrain Stimulation TherapyCognitive TherapyCognitive Behavioral Therapy (CBT)CounselingDance & Movement TherapyDialectical Behavior Therapy (DBT)Eclectic TherapyExposure and Response Prevention (ERP)Forensic TherapyGestalt TherapyHumanistic TherapyHypnotherapyInterpersonal PsychotherapyMarriage and Family Therapy (MFT)MindfulnessMusic TherapyNarrative TherapyNeuro-Linguistic Programming (NLP)NeurofeedbackOnline TherapyParent-Child Interaction Therapy (PCIT)Person-Centered TherapyPlay TherapyPositive PsychologyPsycho-OncologyPsychotherapyRational Emotive Behavioral Therapy (REBT)Sex TherapySomatic TherapyStress ManagementSupport GroupOther:
Preference for Consultation
Face to FaceOnlineHome VisitsOther:
Timings
8am - 9am9am - 10am10am - 11am11am - 12 noon12 noon - 1pm1 pm - 2pm2pm - 3pm3pm - 4pm4pm - 5pm5pm - 6pm6pm - 7pm7pm - 8pm8pm - 9pm9pm - 10pm
Fees per Session

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Anything else you will like us to know?

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