Questionnaire. This information will be displayed on your website.It can be changed any time. "*" indicates required fields Your full name including credentials*Full name of your practice*Is your practice currently a Solo or Group Practice?* Solo Practice Group Practice Do you have any aspirations of growing into a Group Practice?*Select an optionYes, that would be my dream!Maybe, but I'm not sure right now.No, but thanks for asking.Nice! Approximately how many team members are in your group, including both therapists and staff members you'd like to list on your new website?*Select an option234567891011121314151617181920+How many locations does your practice have?*Select an option12345+Practice location* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code What was the opening date / founding date of your practice?* MM slash DD slash YYYY Do you have an existing website?* Yes No Do you have a domain name registered?* Yes No Enter your website address (domain name)*Do you have access to manage your domain name account?*Yes, I have access to my domain settings.No, and I have no idea what you're talking about!I'm not sure. Help!What platform is your existing website on?*Select an optionSquarespaceWixWeeblyWordPressBrightVisionTherapySitesNot SureOtherPlease enter your website platform:*Does your existing website have any original content you'd like to use on the new website?*Select an optionYes, please migrate it for me.NoWould you like to have a blog on your website?*Select an optionYesNoAre there any existing blog posts?*Select an optionYes, please migrate them to my new website.NoEmail address you signed up with Email address to display on the website*(and to receive referrals and online inquiry notifications) Do you have any other email addresses you'll use to send us requests? Please list them below (up to 4, one per line). (For security, we only accept requests from the account owner’s email(s). Any request not from a listed email will be ignored.)Do you have additional email addresses?*Select an optionNo, I only have one email address.Yes, I have multiple email addresses.Please list them all below, one per line. (up to 4)* Add RemovePhone number to display on the website*Do you accept text messages from potential clients seeking services?*Select an optionYesNoDo you offer a free consultation?* Yes No What duration is your free consultation?*Select an option10 minutes15 minutes20 minutes30 minutes40 minutes50 minutes60 minutesHow is your free consultation conducted?* Phone In-person Virtual Do you offer virtual or in-person sessions?*Select an optionVirtual onlyIn-person onlyVirtual and/or in-personWould you like to display your rates on the website?* Yes No What are your rates?*Do you accept insurance?* Yes No Please enter the insurances you accept*What form(s) of payment do you accept?*What is your cancellation policy?*(Please edit the text below to fit your needs. It will appear on the website exactly as written.)If you do not show up for your scheduled therapy appointment, and you have not notified us at least 24 hours in advance, you will be required to pay the full cost of the session.What are the weekly office hours / opening hours of your practice?*(Example: Monday - Friday: 9AM - 5PM, Saturday 10AM-4PM, Sunday CLOSED)Would you like to have a Forms page including these Intake Form PDFs that come free with your website package?* Yes No Do you have a Google Business Profile (GBP) set up?* Yes No Not Sure Are there any Social Media Profiles you'd like to link to on your website?* None Instagram Facebook TikTok YouTube Twitter / X Other Please enter any additional social media profiles below:*Do you have a PsychologyToday profile?* Yes No Do you have a logo, color palette, or any other existing branding assets you'd like to share?*Select an optionYes, I can upload them right now!Yes, but I'll send it to you later.No, not yet!Honestly, I have no idea what you're talking about!Upload branding assets:* Drop files here or Select files Max. file size: 200 MB. To prevent spam, only users in the USA can access your website. By default, all other countries are blocked. Would you like to unblock access from any specific countries?*Select an optionYesNoPlease select the countries you would like unblocked below.*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Let's talk about the Therapy Services, Treatment Specialties, and Treatment Modalities your practice offers. (select Let's get started below)* Let's get started What Therapy Services does your practice offer?*(in other words, what populations do you serve?) Select all that apply:Therapy for Individual AdultsCouples Therapy / Marriage CounselingEMDR (Eye Movement Desensitization and Reprocessing Therapy)Therapy for Teens / AdolescentsFamily TherapyConsulting for Therapists (Supervision, Ongoing Education)Groups and WorkshopsClinical SupervisionTherapy for ChildrenMedication ManagementSex TherapyReproductive Mental HealthPsychedelic Integration ServicesTelehealth in 40 States (PSYPACT)Ketamine-Assisted PsychotherapyExecutive CoachingBreathworkPsychiatric Diagnostic EvaluationsOrganizational ConsultingDissertation and Career Consultation for Graduate StudentsVocational TherapyHypnotherapyGenetic Testing for Mental Health MedicationsMentoringCase Management & Care CoordinationPractice DevelopmentAnxiety and Relationships for Life CoachingParental Consultation for Women with DaughtersOther Please enter any additional Therapy Services*What are your Treatment Specialties?*Select all that apply:AnxietyDepressionRelationship IssuesTrauma / PTSDSelf-Esteem IssuesStress ManagementGrief and LossLife Transitions / ChangesLGBTQ+ IssuesWork and Career IssuesParenting IssuesDivorce and CoParentingSchool and Social IssuesAddiction and RecoveryWomen's IssuesAutism & ADHDSexual AbusePerinatal / Postpartum IssuesPsychedelic TherapiesEating Disorders / Disordered EatingBipolar DisorderGender-Affirming Care for Transgender/Non-BinaryMilitary CounselingOCDInfertilityKinkMen's IssuesFirst RespondersPolyamory / Open RelationshipsKink / BDSMTherapists and Social WorkersFibromyalgiaBurnout PreventionReligion RecoveryIdentity DevelopmentLate-identified Autism and ADHDHighly Sensitive PeopleHealth Psychology (Acute and Chronic Illnesses)Spiritual DirectionSurvivors of Interpersonal ViolenceSports Performance AnxietySurvivors of Human TraffickingMother-Daughter Therapy/CoachingOther Please enter any additional Treatment Specialties*What Treatment Modalities do you offer?*Select all that apply:Cognitive Behavioral Therapy (CBT)Eye Movement Desensitization and Reprocessing Therapy (EMDR)Dialectical Behavior Therapy (DBT)Interpersonal TherapyPsychodynamic PsychotherapyAcceptance and Commitment Therapy (ACT)Internal Family Systems (IFS)Emotionally-Focused Couples Therapy (EFT)Somatic Experiencing (SE)Gottman MethodExposure TherapySolution Focused TherapyMindfulness-Based Cognitive Therapy (MBCT)Humanistic TherapyTrauma-Focused Talk TherapyCompassion-Focused TherapyAttachment-Based TherapyNarrative TherapyFeminist TherapyEmotion-Focused Family TherapyMentalization-Based TherapySolution-Focused Brief Therapy (SFBT)Polyvagal TheoryChristian CounselingStrength-Based TherapyNARM® (NeuroAffective Relational Model)Person-Centered TherapyRelational Life Therapy (RLT)Positive PsychologyCompassionate Mind Therapy (CMT)Compassionate InquiryAccelerated Resolution Therapy (ART)Depth PsychologyPsychobiological Approach to Couples Therapy (PACT)Integrated Approach w/Biblical PrinciplesBrainspottingCognitive Processing TherapyMindful Self-CompassionTranspersonal TherapyOther Please enter any additional Treatment Modalities*Additional Notes (please include anything else you'd like us to know)How did you hear about us?*Select an optionGoogle SearchAI Search (ChatGPT, Gemini, Grok, etc)Referral from Colleague / FriendAnother Therapist's WebsiteFacebook GroupSocial Media (Instagram, Facebook, YouTube)OtherPlease list how you heard about us:*Please list who referred you:*What factors influenced your decision to choose our therapist website design services over others?**