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Counselors for Freedom

3435 Ocean Park Blvd #107-394
Santa Monica, CA 90405

connect@counselorsforfreedom.com

Hello and welcome! We understand it’s a difficult time to be a counseling professional, and we want you to know that you’re not alone. The clients and community you’re looking for exist, and they’re looking for you too. We can’t wait to connect with you and help to connect you with other freedom-minded professionals.

To assist us in getting to know you and a little about what you’re hoping for, we ask that you answer a short series of general questions below.

NOTE: Your information is confidential and will not be shared with anyone outside the Counselors for Freedom core team.

Name

First Name

Last Name

Phone

(###)

###

####

City/Town, State/Province & Country of Residence

I'm interested in...

Being Listed as A Providing Counselor

Peer Support for Counselors

Education, Training & Workshops

Other

Licensure Status

Are you a licensed professional? If so, what license do you hold?

Modality or Specialization

Please describe any particular modality you practice, or area in which you specialize.

Mission & Values Alignment

Please tell us how your values align with the following: "Counselors for Freedom unites mental health professionals of all identities and modalities from across the globe in shared support of health freedom, medical choice, informed consent, and bodily autonomy. We help match potential clients with counselors who respect their right to choose." "We believe that all people, regardless of their medical choices and personal or religious beliefs, should have access to the compassionate psychological care they need, unfettered by the fear of judgment, shaming and/or inappropriate reporting by mental health professionals with differing views. Our vision is competent and inclusive psychological care for all humans that honors their personhood, beliefs, choices, and lifestyles."

Additional Information (Optional)

What else would you like us to know?