Complete Your Onboarding I Therapy works together

Thanks for Joining Us!

Therapy Works Together

Thank you for choosing to contract with us. Please complete your onboarding information below.

Complete Your Onboarding

Name *

First

Last

Email *

State Licenses *

Licensed In (US States, Countries, license numbers and expiration date (e.g. New York #628378 exp: 01/22):

Phone to Share with Clients *

Permanent Address *

Address Line 1

Address Line 2

City

State

Zip Code

Tax ID (SS#, EIN etc) *

Liability Insurance Information *

Please provide your policy number and Insurance company name.

Settings You've Worked In *

Your Bio *

Sample Bio: I graduated from Texas State University with my Masters degree in Communicative Disorders. I have 10 years of speech therapy experience working with children in elementary schools and adults with communication disorders in outpatient facilities. I am experienced with providing therapy in language disorders, feeding and aphasia, and specialize in Beckman Oral Motor Technique and LSVT LOUD for Parkinson's. In my spare time, I enjoy hiking and baking with my kids.

Your Photo *

Click or drag a file to this area to upload.

To share with clients. Should be on a neutral background.

1099-NEC Tax Form (Link below) *

Click or drag a file to this area to upload.

https://www.irs.gov/pub/irs-pdf/f1099nec.pdf

Signed Contract *

Click or drag a file to this area to upload.

Thanks for Joining Us!

Therapy Works Together