Add Your Practice

We welcome other Telebehavioral Medicine Providers to be added to our website free of charge. Please fill out the form below and tell us as much as you can about your practice and someone from or office will contact you.

Name*
First Last
Phone
Phone
Email*
Address
Street Address City State / Province / Region ZIP / Postal Code Country
What Type Of Practice Do You Have?
List States or Regions in Which You Are Licensed To Practice
Check All That You are Licensed to Practice
- Individual Initial Behavioral Medicine Consultation/Evaluation
- Conjoint / Couples Treatment
- Individual or Conjoint Follow up Treatment
- Pain Management Assessment and / or Treatment Follow up
- Medication Management
- Suboxone Treatment
- Independent Behavioral Medical Examination
- Deposition
- Records Review with Report
- Video or Telephonic Testimony
- Tele-Home Monitoring
- Other
How did you hear about us?
- Personal Reference
- Website
- Phone Book
- Other

Add Your Practice

What Type Of Practice Do You Have?