Joining Counselors Care
Dear Provider:

Thank you for your willingness to provide pro-bono mental health services to veterans and/or disaster victims and their families.  To ensure that this is a successful experience, we provide the guidelines below:

  • You agree that in order to join this referral directory you can verify your current state license to practice mental health counseling or other mental health profession.
  • You agree to provide pro-bono services with the same high ethical and professional standards as are used in your general practice and that you have malpractice insurance.
  • You agree to be responsible for screening referrals to determine whether they are appropriate for your scope of training and scope of practice.  If not you will refer them back to this referral directory or on to qualified professionals, or both.
  • You agree to provide at 3 - 5 free counseling sessions to each referral from this program.  You will decide how many pro-bono clients you want to take on at any given time.  It will also be up to you if you want to continue the treatment beyond the free sessions and under what terms you and the client agree upon.
  • You agree to update your availability status and contact information so that the information you give us is always current.
  • You agree to notify NYMHCA, ASAP in the event you can no longer provide pro-bono services as part of this program.

If you are in agreement with the above guidelines, fill out the form below and click the "submit form" button.  You will receive an email notifcation that your information has been received.
Title:
First Name:
Last Name:
Type of License(s):  (LMHC, LMFT, etc.)
Office or Practice Name:
Address:
City:
State:
ZIP Code:
Phone:
Email:
Website:
Number of free sessions offered to each client:
Areas of Expertise:
*I understand and accept that if I volunteer as a disaster relief counselor, my name and contact info will be given to AMHCA (American Mental Health Counselors Association) to be added to a national registry of volunteer disaster relief counselors.  I also understand that I am in no way obligated to volunteer my services to other than pro-bono clients in the area where I practice.
I accept.Do not add my name to the national registry.