Provider Application Form

If you are a licensed, sex positive and all gender and lifestyle affirming clinician, physical or mental health provider, or wellness provider, please fill out the form below to be considered for a listing on ManhattanAlternative.com. Please note that listing priority is given to those who know personally and are referred by an existing ManhattanAlternative.com provider, and who have multiple personal connections to the communities we serve. The timing for the addition of new listings varies widely from a day to several weeks or longer.

  • Accepted file types: jpg, gif, png, pdf, jpeg.
  • Please note that they will be contacted to verify your connection, and listing priority is given to those who are referred by someone already on the site.
  • This field is for validation purposes and should be left unchanged.