FindaPsychologist.org Listing Questionnaire

Thank you for taking a moment to complete this four-question survey.

Question Title

* 1. Please let us know who you are.

First & Last Name

Registrant ID or Email

Question Title

* 2. Do you accept any healthcare/insurance plans?

Yes

Question Title

* 3. If applicable, are you enrolled as a:

Medicare Provider

Medicaid Provider

TRICARE Provider

Question Title

* 4. If applicable, list up to five additional healthcare/insurance plans accepted.

Plan #1

Plan #2

Plan #3

Plan #4

Plan #5

Thank you for completing this questionnaire! If you would like to add a new or updated photograph to your FindaPsychologist.org listing, please email a copy to Samantha@nationalregister.org.