Provider Application Form - Manhattan Alternative

Please note: While we are now accepting applications from providers who identify within at least one of our communities of focus (i.e., LGBQ, trans/GNC, kink/BDSM, poly/CNM, current/former adult industry workers), we will continue to prioritize BIPOC/PGM providers with one or more of those identities, as well as others who have multiple 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.

Name (as you would like it to appear on the site)*
Pronouns (if you would like them included on the site)
Honorific (if you would like it included on the site):
- Dr.
- Mx.
- Ms.
- Mr.
- Mrs.
Degrees/Licenses/Certifications (must be directly associated with/in support of the profession you are listing)*
If your license requires that you practice under supervision (e.g., LMSW), please indicate the name and email address of your supervisor for confirmation (I will send a brief email to confirm):
Title (this will appear under your name on the main page; e.g., psychotherapist, psychologist, psychiatrist, etc)*
Subtitle/Specialization (this will appear under your title on the main page; usually keywords indicating your areas of focus, specific populations, treatment approaches, etc; see other profiles on the main page for examples)—please note that this line has a maximum of about 29 characters including spaces*
Website (must be to your web or profile page, not a general practice page (unless you're the only person at the practice))*
Email (messages must go directly to you, rather than admin staff at a general practice (unless you're the only person at the practice))*
Phone (must be a direct phone number, not a general practice phone number; if you'd rather not list your phone number on your profile, please include something else for this field in order to fit the template, such as another page on your website, a different website, or a social media handle)*
Facebook Page (optional)
LinkedIn Profile URL (optional)
Instagram Handle (optional)
Please include a 100 (minimum) to 125 (maximum) word bio for your individual profile page.*
Upload Photo: Must be a minimum of 640×640 dpi, and maximum 64 MB file size. It's fine to submit photos larger than 640×640 (and up to 64 MB); they will be cropped and downsized to fit. Please do not submit photos with original dimensions smaller than 640×640, as they may be blurry/too pixelated.*
Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 256 MB.
Who referred you to ManhattanAlternative.com? (Please note: We will send a brief email to confirm they know you, with all identity information removed per the privacy protocol; and listing priority is given to those who are referred by someone already on the site.)*
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):
- Psychotherapist
- Sex Therapist
- Trainer/Coach
- Body Worker
- Doula
- Energy Worker
- Physical Health Care Provider
- Psychiatrist/Medication Management
- Voice Coach
- Bilingual/Multilingual Provider
- BIPOC/PGM Provider
- Trans/Non-Binary Provider
Please indicate the Provider Availability filter(s) you would like to be included in:
- Currently Accepting Inquiries (e.g., waitlists, drop-ins, letters, referrals)
- Currently Accepting New Clients
- In-person
- Remote/Telehealth
- Insurance (must be in-network with insurance)
- Sliding Scale
If you selected "Insurance," please list any insurance panels you're in-network with here:
Please indicate the client age populations you work with:
- Adolescents
- Adults
- Children
- Older Adults
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):
- BDSM/Kink
- CNM/Poly
- GNC/Trans
- LGB/Queer/Non-Straight
- Disability Justice
- Fat Liberation/Body Liberation
- Immigration
- Neurodiversity Affirming
- Sex Worker Friendly
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:
- ADHD
- Anger Management
- Anxiety
- ASD/Neurodivergence
- Bipolar 1 or 2
- Borderline PD
- Chronic Illness
- Complex Trauma
- Conflict Avoidance
- Depression
- Disordered Eating
- Grief/Bereavement
- HIV+/Poz
- Intimate Partner Violence
- Minor-Attracted People
- OCD
- PTSD
- Relationship Conflict
- Self-Harm
- Sexual Assault/Abuse
- Substance/Alcohol Use/Misuse
- Suicidal Ideation
The following category filters allow clients to identify providers who practice particular modalities or types of therapy/assessments:
- Couples Therapy/Multi-Partner Therapy/Relationship Therapy
- Family Therapy
- Group Therapy
- Neuropsych Assessments
- Gender Affirming Care Letters
- CBT
- Creative Arts Therapy
- DBT
- EMDR
- Harm Reduction
- Hypnotherapy
- Internal Family Systems
- Palliative
- Pleasure-Informed
- Psychodynamic
- Somatic
- Trauma-Informed
In which state(s)/territory(ies) are you licensed and able to work with clients?*
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- District of Columbia
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Puerto Rico
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Virgin Islands
- Washington
- West Virginia
- Wisconsin
- Wyoming
*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):
- BDSM/Kink
- CNM/Poly
- LGB/Queer/Non-Straight
- GNC/Trans
- Current/Former Sex Worker
How has your personal experience impacted your kink/poly/trans/LGBQ clinical competence?*
If you identify as an ally to one or more of these communities, how do you practice being kink/poly/trans/LGBQ-affirmative and -competent?*
Do you lack clinical competency in any areas related to non-mainstream (i.e., kink, poly, CNM, LGBQ, trans, GNC, etc) identifications, communities, and/or practices? If so, what are they, and how are you working toward improvement in those areas?*
Please describe your reason(s) for wanting to work with kink/poly/trans/LGBQ-identified individuals.*
Please describe any work you have done directly with LGBTQ-identified, kink-identified, and/or poly-identified people and communities.*
Please list any publications you’ve authored/co-authored relating to these populations.
Please list any conference presentations or facilitation of clinical seminars relating to these populations.
The Manhattan Alternative Providers listserv is primarily for giving and receiving referrals and sharing community resources. If you would like to be added to the listserv, please enter your preferred email address, i.e., the one you'd like visible to the community when you post or reply. Please note that if you have a GMail email, you will have more control over your frequency preferences, if not you can just ask us to adjust your frequency preferences. If you don't want to be on the listserv, please enter N/A.*

Please read and follow ManhattanAlternative.com/community-guidelines; if the guidelines are not followed, you will be removed from the site.
Anti-racism agreement*
I am anti-racist, and I am committed to dismantling white supremacy.
Please read and follow ManhattanAlternative.com/community-guidelines; if the guidelines are not followed, you will be removed from the site.
Non-exploitation agreement*
I agree to follow Community Guidelines, and to avoid any behavior that would exploit community members, supervisees, employees, and colleagues.
Please read and follow ManhattanAlternative.com/community-guidelines; if the guidelines are not followed, you will be removed from the site.
Consent*
I agree to the privacy policy.
Please read ManhattanAlternative.com/privacy-protocol to learn about steps taken to ensure your information is kept private.
Comments
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