Therapist Registration Form

Join our network of verified mental health professionals

Please read all instructions carefully before filling this form. Fields marked * are mandatory. Applications with incomplete or unclear documents may be rejected.

Applicant Details

Fill in the details below. Fields marked * are required.

01Personal Details

Full Name *

Email Address *

Phone Number *

02Professional Profile

Profile Type *

Counselling Psychologist

Psychiatrist

Clinical Psychologist

Special Educator

Preferred Service Mode *

Virtual

In-Person

Both

03Areas of Expertise

Select all the services you are interested to offer.

Prescribe Medication (Only for Psychiatrist)Individual CounsellingCouple CounsellingTeen CounsellingWorkshops / EventsInternship / Training

04Verification Documents

We verify every therapist before listing them publicly. Please upload clear, valid documents.

Resume / CV *

Click or drag & dropPDF, DOC — max 5MB

Highest Qualification Certificate *

Click or drag & dropDegree / diploma certificate — PDF, JPG, PNG — max 5MB

ID Card Type *

Any government-issued photo ID such as Aadhar Card or PAN Card is accepted.

Upload ID Card *

Click or drag & drop — JPG, PNG, PDF · max 5MB

I agree to the Terms & Conditions and Privacy Policy. I confirm that all information and documents provided are accurate, valid, and belong to me.

Before You Submit

Applications are reviewed within 1–2 business days of submission.
Keep your Resume, Qualification Certificate, and ID Card clear and valid — blurry or incomplete documents can delay approval.
Your ID Card is used only for identity verification and is never shown on your public profile.
You will be notified of approval on your registered email and phone number.

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Therapist Registration Form

Applicant Details