QUALIFICATION SURVEY:
Thank you for your interest in using the Talkspace platform for your therapy practice. The following questions are all prerequisites for using the Talkspace platform as a therapist, so please ensure that all questions are answered accurately.

Note: An iPhone 4S or iPad 2 (or newer) is required in order to use the Talkspace therapist platform.
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First Name: *

 
Last Name: *

 
Do you have at least 3 years of clinical work experience? *

     
 
Are you licensed in the United States? *

     
 
Your license number: *

 
Have you completed your supervision hours and licensing exams? *

     
 
Do you have a license, and does the license allow you to diagnose clients in that state? *

     
 
Do you have any disciplinary actions on file? *

     
 
Do you have malpractice insurance? *

     
 
Before submitting your application, please take a moment to ensure that you have answered all questions accurately.

(You can scroll up to view previous questions, or use the up and down arrows on your keyboard to navigate.)
Thank you for submitting your Qualification Survey. You will receive an email with further instructions regarding your application.
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