Acknowledgment and Consent for Participating Psychotherapists
Thank you for considering participation in our Access for All Community Response Program. In these unprecedented times, we appreciate your willingness to donate your valuable service.
Participating clinicians must read and agree to the program guidelines listed below. Once this certification form is submitted by the clinician and reviewed by The Wingspan Project, contact information for participating clinicians will be posted on the Access For All Community Response page.
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I have read and hereby certify the following:
I also agree to provide at least one hour of pro-bono psychotherapy services per week for a minimum 10 week period to a person who engages me through The Wingspan Project’s Access for All Community Response Program. In that capacity, I will give priority to one or both of the following:
I understand that as a participating clinician I have no legal affiliation with The Wingspan Project (“TWP”) and am not covered by TWP liability and/or malpractice insurance. |
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