Online Counseling/Coaching Application Questions

Question Title

* 1. Contact Information (Business)

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Cell Phone Number

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* 2. How much time do you think can you devote to counseling on rTribe per week? (Select more than one answer if you are unsure.)

1-5 hours a week.

5-10 hours a week.

11-15 hours a week.

15-25 hours a week.

25+ hours a week.

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* 3. Are you a Lifecoach or Wellness Coach?

Yes

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* 4. Are you a Licensed Clinician?

Yes

If Licensed, what is your License Type and #?

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* 5. How many years have you been providing counseling and/or coaching?

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* 6. Do you have experience providing online counseling or coaching? If so, please explain.

Yes

If Yes, please explain

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* 7. Please provide 1-3 people who can serve as a reference. List licensed counselors, if you're a licensed therapist, or list certified coaches if you're applying as a coach. Don't forget to include their contact information INCLUDING E-MAIL.

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* 8. Are you willing to conduct Live Video sessions? At this time, it's a requirement :)

Yes

I'm uncertain.

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* 9. How often do you check your email?

Constantly

Multiple times a day

Daily

Multiple times a week

Weekly

Less than once a week

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* 10. Have you ever been subject to an investigation, review, or discipline by your licensing board? If so, please provide details.

Yes

If Yes, please explain

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* 11. Are you able to provide services in a language other than English? If so, which language(s)?

Yes

If Yes, please list which language(s)

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* 12. Please describe in 2-3 sentences your counseling/coaching modalities, style, and approach.

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* 13. Share a little about why you are interested in joining the rTribe community:

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* 14. Select all of your Specialties or Areas of Focus (this is the 'struggles' list clients will choose from):

Alcohol

Anxiety

Anger

Codependency

Couples

Depression

Drugs

Food

Gambling

Gaming

Grief

Internet

Over-exercise

Partner of an addict

Pornography/Sex

Relationships

Shame

Shopping/Overspending

Smoking

Work

Other, please list

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* 15. If you chose "Couple's", please share some of the experience you have working specifically with them on all platforms (i.e. In-Office, Video):

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* 16. Do you have malpractice insurance? (For Licensed Clinicians)

Yes

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* 17. Are you Certified? If so, please list certifications

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* 18. What is your highest level of education? Please list Institution, Degree and Graduation Year.

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* 19. How did you hear about rTribe online counseling?

Internet Search

Apple App/Google Play Store Search

An Ad Online

Word of mouth

From a client

From a counselor or coach, please share their name below.

That’s it!

Thanks for taking the time to respond. We'll be in touch soon.

The rTribe team

Question Title

* 20. Do you have any questions for us?

Yes

If Yes, please share your questions.

We want to get to know you better! Please take a few minutes to answer these questions so we can better understand if you're a good fit for our online counseling/coaching platform, and how we can best support you and our community. Tribe On! Alex, Josh, and the rTribe Team

Question Title

* 1. Contact Information (Business)

Question Title

* 2. How much time do you think can you devote to counseling on rTribe per week? (Select more than one answer if you are unsure.)

Question Title

* 3. Are you a Lifecoach or Wellness Coach?

Question Title

* 4. Are you a Licensed Clinician?

Question Title

* 5. How many years have you been providing counseling and/or coaching?

Question Title

* 6. Do you have experience providing online counseling or coaching? If so, please explain.

Question Title

* 7. Please provide 1-3 people who can serve as a reference. List licensed counselors, if you're a licensed therapist, or list certified coaches if you're applying as a coach. Don't forget to include their contact information INCLUDING E-MAIL.

Question Title

* 8. Are you willing to conduct Live Video sessions? At this time, it's a requirement :)

Question Title

* 9. How often do you check your email?

Question Title

* 10. Have you ever been subject to an investigation, review, or discipline by your licensing board? If so, please provide details.

Question Title

* 11. Are you able to provide services in a language other than English? If so, which language(s)?

Question Title

* 12. Please describe in 2-3 sentences your counseling/coaching modalities, style, and approach.

Question Title

* 13. Share a little about why you are interested in joining the rTribe community:

Question Title

* 14. Select all of your Specialties or Areas of Focus (this is the 'struggles' list clients will choose from):

Question Title

* 15. If you chose "Couple's", please share some of the experience you have working specifically with them on all platforms (i.e. In-Office, Video):

Question Title

* 16. Do you have malpractice insurance? (For Licensed Clinicians)

Question Title

* 17. Are you Certified? If so, please list certifications

Question Title

* 18. What is your highest level of education? Please list Institution, Degree and Graduation Year.

Question Title

* 19. How did you hear about rTribe online counseling?

Question Title

* 20. Do you have any questions for us?

We want to get to know you better!

Please take a few minutes to answer these questions so we can better understand if you're a good fit for our online counseling/coaching platform, and how we can best support you and our community.

Tribe On!

Alex, Josh, and the rTribe Team