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Listing Update Form
Listing Update Form
Please fill out the form below if you currently have a profile on ManhattanAlternative.com and would like to make updates to your profile (please fill out only what you'd like updated).
Name
*
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:
Title (e.g., psychotherapist, psychologist, psychiatrist, etc)
Specialization/2nd Title (e.g., areas of focus, specific populations, treatment approaches, etc)—please note that this line has a maximum of about 32 characters including spaces
Phone
Email
Website
Facebook Page (optional)
LinkedIn Profile URL (optional)
If you accept insurance or have stopped accepting insurance, please list which insurance plans you'd like added or removed:
If you would like to update your bio, please enter 100 (minimum) to 125 (maximum) words here:
Upload Photo: Must be a minimum of 640x640 dpi, and maximum 64 MB file size. It's fine to submit photos larger than 640x640 (and up to 64 MB); they will be cropped and downsized to fit. Please do not submit photos with original dimensions smaller than 640x640, as they may be blurry/too pixelated.
Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 256 MB.
Please indicate the category filter(s) you would like to be included in (please select all currently applicable categories, not just new ones you're adding):
alternative healer
BDSM/kink
CNM/poly
currently accepting inquiries (e.g., wait lists, drop ins, letters, referrals)
currently accepting new clients
disability
disordered eating
GNC/trans
Health Care Providers
insurance (in-network)
LBG/queer/non-straight
pleasure-informed
POC-identified provider
psychiatrist
sex therapist
sex worker friendly
sliding scale
somatic
substance use/misuse
therapist
trainer/coach
trauma-informed
New listserv email (if you would like to update your listserv email, enter the new email here):
Remove listserv email (if you would like to remove your previous listserv email, enter it here):
Questions, comments, clarifications:
Consent
*
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Comments
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