About You and Your Services Degree / Credentials
Which category best describes you? *
Expressive Arts Business Name (if different from your name)
Business Address (please include street, city, state, zip) *
What is your cost per session? *
Which payment options do you accept? Select all that apply. *
Sliding scale What insurance do you accept? *
Which populations do you treat? Select all that apply. *
People with Disabilities
People in Larger Bodies What are your specializations? Select all that apply.
Binge Eating Disorder
Body Dysmorphic Disorder
Addiction/Substance Use Disorder What is your treatment approach? Select all that apply.
Cognitive Behavioral Therapy (CBT)
Dialectical Behavioral Therapy (DBT)
Eye Movement Desensitization and Reprocessing (EMDR)
Experiential Therapy Do you offer services in any languages other than English? If so, please specify. *
Are you available for free assessments? *
No Are you interested in starting an ANAD affiliated support group? *
No Are you interested in applying for ANAD’s Inclusive Care Seal of Approval? *
No Please provide a short biography about yourself, your practice, and your treatment approach. This will be included in your listing in ANAD’s treatment directory.
* Please note: if you answer “yes” to any of the following questions, we will follow up with you by phone. Have you ever been denied membership or been disciplined by any professional society? *
No Have you ever been involved in a malpractice action? *
No Do you have any professional liability complaints pending against you? *
If you answered “yes” to any of the questions above, please provide an explanation below.
Please type your full name and today's date below as your signature, indicating that all information provided above is accurate and truthful. *