Adoptee-Therapist Directory Featured Therapist Submission Form

Example of the Featured Adoptee-Therapist Banner that will be listed at the top of your state page.

I confirm that I have completed a full profile submission separately or am already listed in the directory. *

Confirm

I understand that my Featured Therapist request allows me to be listed under a maximum of 3 states per submission, and that no more than 3 Featured Therapists will be listed under a state at a time to ensure visibility to my profile. *

Confirm

Name *

First

Last

States where I would like to be featured: *

Upload a headshot: *

Drag & Drop Files, Choose Files to Upload

List any updates/revisions that you'd like to make to your profile:

Would you like to be listed as a Featured Therapist for 30 or 90 days? You will be notified when your Featured Therapist banner date begins. *

Stripe Credit Card *