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Provider Application Form

Manhattan Alternative is a listing site and community for providers who identify within at least one of the following umbrellas: LGBQ, trans/GNC, kink/BDSM, poly/CNM, and those with a history of adult industry work. Please note: While we are now accepting applications from providers who identify within at least one of the communities just mentioned, we will continue to prioritize BIPOC/PGM providers with one or more of those identities, as well as others who have multiple intersecting personal connections to our communities of focus. Please read ManhattanAlternative.com/Privacy-Protocol to learn about steps taken to ensure your information is kept private.

Listing priority is also given to those who are referred by an existing ManhattanAlternative.com provider that they know personally. Please also note that when reviewing listing submissions, we also take into account the written content of the listing submission, as well as evidence of shared values in language used on other websites (e.g., direct website, Psychology Today profile, social media, etc). This means that timing for screening and publishing new listings can vary widely, from the same day to several weeks or longer. We try to respond to every inquiry and follow up email but we may not always be able to; please don’t take it personally.

This is for new listings only; to update a current listing, go to ManhattanAlternative.com/Listing-Update-Form.

"*" indicates required fields

Honorific (if you would like it included on the site):

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 50 MB.
Please indicate the Provider Type filter(s) you would like to be included in (must have related credentials to be included in the therapist, psychiatrist/medication management, and health care provider categories):
Please indicate the Provider Availability filter(s) you would like to be included in:
Please indicate the client age populations you work with:
The following category filters are to help clients narrow down their search for providers, please indicate the category filter(s) you would like to be included in (in other words, these categories indicate providers' therapeutic specializations, not necessarily providers' identities):
The following category filters are to help clients narrow down their search for providers, please indicate the Issues filter(s) you would like to be included in:
The following category filters allow clients to identify providers who practice particular modalities or types of therapy/assessments:
In which state(s)/territory(ies) are you licensed and able to work with clients?*
*Listing priority is given to those who have multiple personal connections to the communities we serve. Please indicate whether you are or have been personally affiliated with any of the following identities/communities/practices (this information is used for screening purposes only, is kept private, and will be permanently deleted after the screening process):
This field is for validation purposes and should be left unchanged.