Group Practice

If you would like to highlight specific providers at your practice, please consider filling out the individual practitioner form linked here.

Provider Information

Practice Name

Administrative Contact Email (will not be shared with clients)

Administrative Contact Phone (will not be shared with clients)

Clinical Offerings

Population(s) that your practice services::

Can you provide services in any other languages besides English?

Client Contact Information

Website URL

Link to appointment scheduling page (if you have one)

Intake Email (for clients)

Intake Phone Number (for clients)

Insurance Information

Please share your self pay rates and whether you have sliding fee scale

Location Information

How are you providing services

In-Person Only

Virtually Only

Hybrid (In-Person and Virtually)

Networking Information

Use this section to provide any pertinent practice updates for our team to know (i.e. new support groups, growth and more).

Would you like to schedule a virtual meeting with Suzanne Muirheid, CEO and Clinical Director, to explore opportunities for collaboration?

Would you have interest in Suzanne Muirheid, CEO and Clinical Director, speaking to your team about EMDR services and how to provide a referral to Calm Mind?

Which Calm Mind Counseling Center provider sent you this form?