User account

Account information

Note: Once you begin the registration process, please do not exit the system or click the back button on your browser. This may cause problems with your membership application, including loss of data, which would require you to reenter your information.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Password: *

Confirm password: *

Please choose a password for your account; it must be at least 6 characters.

Desired Username: *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.

Personal Information

First Name: *

Middle Name:

Last Name: *

Gender: *

Date of Birth:

Year:

Month:

Day:

Professional Information

Continue the application process by filling in your professional information. Please complete all fields as completely and accurate as possible so that we can provide your potential clients as much information about you as possible.

Years in Practice: *

How many years have you been in practice?

Licensed in: *

Professional License Number: *

License Expiration Date: *

Degree: *

Please select your primary degree.

Institution: *

From which institution did you receive this degree?

Date Degree Received:

Enter the month and year you received this degree.

Professional Organizations/Affiliations:

Please list professional associations.

Professional Title(s):

Please select the titles which apply to your profession.

Other Professional Title(s):

Enter any other titles that pertain to you that are not listed.

Therapeutic Orientation(s): *

Please select your therapeutic orientations.

Other Therapeutic Orientation(s):

If another orientation pertains to you and is not listed, please enter it here.

Specialties: *

Please select your specialty or specialties (up to 10).

Other Specialties:

If another specialty pertains to you and is not listed, please enter it here.

Treatment Modalities: *

Please select the treatment modalities most commonly used.

Other Treatment Modalities:

If another modality pertains to you and is not listed, please enter it here.

General Comments:

Practice Information

Next, please tell us about your practice Please complete all fields as completely and accurate as possible so that we can provide your potential clients as much information about you as possible.

Address: *

City: *

State: *

Zip code: *

Please enter your practice's address. You must include a street address to be included in search results. DO NOT add notes, building/practice name, or additional location information to your address. Doing so may result in incorrect mapping of your location or cause your listing to be excluded from search results. Enter suite/unit numbers on the second line.

Website:

Phone: *

Fax:

Treatment Age(s): *

Which type of patients do you treat?

Accepted Insurance: *

Which insurance companies do you accept?

Other Accepted Insurance:

If you accept insurance that is not listed, please enter it here.

Malpractice Insurance Carrier: *

Malpractice Policy Number: *

Please enter your malpractice insurance policy number.

Malpractice Policy Expiration Date: *

Minimum Hourly Fee: *

Other Languages:

Please enter any languages other than English which you speak.

Lastly, where did you hear about 4therapy.com? *

Membership Agreement

In order to submit your application, you must read and agree to the following:

REGISTRATION AGREEMENT

THE TERMS OF THIS REGISTRATION AGREEMENT ARE IMPORTANT AND SHOULD BE 
READ CAREFULLY AND COMPLETELY.  BY ACKNOWLEDGING YOUR ACCEPTANCE YOU 
AGREE TO BE BOUND BY THE TERMS OF THIS AGREEMENT.
 
1. Acceptance of Terms 
4therapy.com NETWORK would like to welcome you to our website.  
4therapy.com NETWORK provides its service to you, subject to this 
Agreement ("Agreement") which may be updated by us from time to time. In
 addition, when using particular 4therapy.com NETWORK services, you 
shall be subject to any posted guidelines applicable to such services. 
All such guidelines are hereby incorporated by reference in the 
Agreement. Prior to using any of the 4Therapy.com NETWORK services, you 
the Mental Health Professional (also referred to as the "MHP"), are 
required to declare that have carefully read this agreement and to 
accept and agree the terms and conditions detailed below.

 
2. Description of Service
4therapy.com NETWORK provides subscribers with access to information 
relating to mental health and personal development (the "Service"). 
Unless explicitly stated otherwise, any new features that augment or 
enhance the Service shall be subject to the Agreement. 4therapy.com 
NETWORK assumes no responsibility for the timeliness, deletion, 
mis-delivery or failure to store any user communications or 
personalization settings.

You are an independent practitioner and not in any way an employee or 
agent of 4therapy.com NETWORK. After you register you may use the 
infrastructure that we make available to you and participate on the 
website by posting articles, hosting chat rooms, and interacting with 
consumers in general. You are solely responsible for your actions in 
this regard. You are also solely responsible for your contact and 
interaction with consumers and other mental health professionals both in
 or out of the 4therapy.com NETWORK.  This includes interactions that 
you choose to take offline. The arrangements you make with consumers for
 fees and billings are strictly your responsibility. 

To use the Service, you must obtain access to the World Wide Web, either
 directly or through devices that access Web-based content, and pay any 
service fees associated with such access. In addition, you must provide 
all equipment necessary to make such connection to the World Wide Web, 
including a computer or modem or other access device. 

The 4therapy.com NETWORK services are offered only to professionals that
 are currently licensed and in good standing with all applicable 
regulatory agencies and are 18 years of age or older at the time of 
registration. By registering for the service, you certify that you are 
18 years of age or older.


3. Cost of Service 
The 4therapy.com NETWORK provides MHPs access to its services in 
exchange for a $60 monthly subscription fee.  During the new member 
registration process, MHPs are required to provide valid billing 
information, which includes: a credit card number and expiration date, 
their name as it appears on their credit card, billing address, city, 
state, zip code, country and telephone number. 


4. Billing Procedures
If a free trial period is extended to you, your credit card will not be 
billed during this time. Once your free trial period has ended, 4therapy
 will automatically bill your credit card at a rate of $60.00 each 
month.


5. Privacy Policy 
The 4therapy.com NETWORK shall maintain the confidentiality of 
information in its possession provided by you to it in accordance with 
applicable state and federal laws and regulations or other applicable 
law, and shall not release such information to any other person or 
entity, except as permitted by law or in accordance with a validly 
executed release (see 4therapy.com NETWORK Privacy Statement), or by 
court order. 


6. Your Registration Obligations
In consideration of use of the Service, you agree to: (a) provide true, 
accurate, current and complete information about yourself as prompted by
 the Service's registration form (such information being the 
"Registration Data") and (b) maintain and promptly update the 
Registration Data to keep it true, accurate, current and complete. If 
you provide any information that is untrue, inaccurate, not current or 
incomplete, or 4therapy.com NETWORK has reasonable grounds to suspect 
that such information is untrue, inaccurate, not current or incomplete, 
4therapy.com NETWORK has the right to suspend or terminate your account 
and refuse any and all current or future use of the Service (or any 
portion thereof).  If you fail to maintain your professional license 
this Agreement will be automatically terminated. [4therapy.com NETWORK 
relies on registered professionals to provide accurate information and 
assumes no responsibility for verifying the information provided.  We do
 however, reserve the right for any reason to verify any information 
provided by professionals registered with 4therapy.com NETWORK.]


7. Conduct 
You are obligated to conduct yourself in a responsible and ethical 
manner while using this website, and while interacting with consumers, 
other participants and professionals, or the staff of 4therapy.com 
NETWORK.  You are also obligated to comply in every respect with all 
ethical guidelines applying to your particular profession, and the 
guidelines of the State and other jurisdictions in which you practice.  
By acceptance of this Agreement you agree that you will: 

(a) conduct yourself in an ethical manner while using this website, and 
while interacting with consumers, other participants and professionals, 
or the staff of 4therapy.com NETWORK.

(b) not upload, post, email or otherwise transmit any content that is 
unlawful or could be construed as harmful, threatening, abusive, 
harassing, tortuous, defamatory, vulgar, obscene, libelous, invasive of 
another's privacy, hateful or racially, ethnically or otherwise 
objectionable;

(c) not upload, post, e-mail or otherwise transmit any content that you 
do not have a right to transmit under any law or under contractual or 
fiduciary relationships (such as inside information, proprietary and 
confidential information learned or disclosed as part of employment 
relationships or under nondisclosure agreements);

(d) not upload, post, e-mail or otherwise transmit any material that 
contains software viruses or any other computer code, files or programs 
designed to interrupt, destroy or limit the functionality of any 
computer software or hardware or telecommunications equipment;

(e) not impersonate any person or entity;

(f) not disrupt the normal flow of dialogue, cause a screen to "scroll" 
faster than other users of the Service are able to type, or otherwise 
act in a manner that negatively affects other users' ability to engage 
in real time exchanges;

(g) not intentionally or unintentionally violate any applicable local, 
state, national or international law;

(h) not "stalk" or otherwise harass another; or

(i) not collect or store personal data about other users without their 
express permission.


8. Indemnity 
To the fullest extent permitted by law you agree to indemnify and hold 
harmless 4therapy.com NETWORK, and its subsidiaries, affiliates, 
officers, agents, directors, co-branders or other partners, and 
employees from any loss, damage, expense, liability, claim or demand, 
including reasonable attorneys' fees, made by any third party as a 
result of, related to or arising out of, your use of the Service, your 
connection to the Service, your violation of the Agreement, or your 
violation of any rights of another. 

In no event shall 4therapy.com NETWORK be liable for any indirect, 
consequential, special or punitive damages, including any "lost 
opportunity" costs.   


9. Passwords and Security
You will create a password and user name upon completing the Service's 
registration process. It is your responsibility to maintain the 
confidentiality of the password and you are fully responsible for all 
activities that occur under your password. You agree to (a) immediately 
notify 4therapy.com NETWORK of any unauthorized use of your password or 
any other breach of security, and (b) ensure that you exit from the Web 
site at the end of each session. 4therapy.com NETWORK cannot and will 
not be liable for any loss or damage arising from your failure to comply
 with this Section 7.


10. No Resale of Service 
You agree not to reproduce, duplicate, copy, sell, resell or exploit for
 any commercial, unauthorized or other unintended purposes, any portion 
of the Service, use of the Service, or access to the Service. 


11. General Practices Regarding Use and Storage 
You acknowledge that 4therapy.com NETWORK may establish general 
practices and limits concerning use of the Service. You agree that 
4therapy.com NETWORK has no responsibility or liability for the deletion
 or failure to store any messages and other communications or other 
content maintained or transmitted by the Service. You acknowledge that 
4therapy.com NETWORK reserves the right to log off accounts that are 
inactive for an extended period of time. You further acknowledge that 
4therapy.com NETWORK reserves the right to change these general 
practices and limits at any time, in its sole discretion, with or 
without notice. 


12. Modifications to Service
4therapy.com NETWORK reserves the right at any time and from time to 
time to modify or discontinue, temporarily or permanently, the Service 
(or any part thereof) with or without notice. You agree that 
4therapy.com NETWORK shall not be liable to you or to any third party 
for any modification, suspension or discontinuance of the Service.


13. Termination 
You agree that 4therapy.com NETWORK, in its sole discretion, may 
terminate your password or use of the Service, and remove and discard 
any content within the Service, for any reason. 4therapy.com NETWORK may
 also in its sole discretion and at any time discontinue providing the 
Service, or any part thereof, with or without notice. You agree that any
 termination of your access to the Service under any provision of this 
Agreement may be effected without prior notice, and acknowledge and 
agree that 4therapy.com NETWORK may immediately deactivate or delete 
your account and all related information and files in your account 
and/or bar any further access to such files or the Service. Further, you
 agree that 4therapy.com NETWORK shall not be liable to you or any 
third-party for any termination of your access to the Service.


14. Cancellation by MHP
You have the right to cancel your account at any time; however, 
4therapy.com NETWORK requires written notification 2 business days prior
 to your billing date, in order to prevent any automatic billing that 
might be pending.  Therefore, you agree to notify 4therapy.com NETWORK 
IN WRITING, by either email or postal mail, at least 2 business days in 
advance of your billing date concerning any intention to cancel your 
account.  You also agree that failure to notify 4therapy.com NETWORK in 
writing 2 business days prior to your billing date will result in the 
applicable fee being charged for the next month's cycle and no refund 
shall be granted. 

Further, you agree that you will contact 4therapy.com NETWORK regarding 
any questions on billing, and shall NOT seek restitution from the 
applicable credit card agency without first attempting to resolve any 
issues directly with 4therapy.com NETWORK.


15. 4therapy.com NETWORK's Proprietary Rights 
You acknowledge and agree that the service and any necessary software 
used in connection with the Service ("Software") contain proprietary and
 confidential information that is protected by applicable intellectual 
property and other laws. You further acknowledge and agree that 
information presented to you through the Service is protected by 
copyrights, trademarks, service marks, patents or other proprietary 
rights and laws. Except as expressly authorized by 4therapy.com NETWORK,
 you agree not to modify, rent, lease, loan, sell, distribute or create 
derivative works based on the Service or the Software, in whole or in 
part. 
You agree not to (and not to allow any third party to) copy, modify, 
create a derivative work of, reverse engineer, reverse assemble or 
otherwise attempt to discover any source code, sell, assign, sublicense,
 grant a security interest in or otherwise transfer any right in the 
Software. You agree not to modify the Software in any manner or form, or
 to use modified versions of the Software, including (without 
limitation) for the purpose of obtaining unauthorized access to the 
Service. You agree not to access the Service by any means other than 
through the interface that is provided by 4therapy.com NETWORK for use 
in accessing the Service.


16. Disclaimer of Warranties 
YOU EXPRESSLY UNDERSTAND AND AGREE THAT: 
YOUR USE OF THE SERVICE IS AT YOUR SOLE RISK. THE SERVICE IS PROVIDED ON
 AN "AS IS" AND "AS AVAILABLE" BASIS. 4THERAPY.COM NETWORK EXPRESSLY 
DISCLAIMS ALL WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, 
INCLUDING, BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY,
 FITNESS FOR A PARTICULAR PURPOSE AND NON-INFRINGEMENT. 
4THERAPY.COM NETWORK MAKES NO WARRANTY THAT (i) THE SERVICE WILL MEET 
YOUR NEEDS, (ii) THE SERVICE WILL BE UNINTERRUPTED, TIMELY OR 
ERROR-FREE, (iii) THE RESULTS THAT MAY BE OBTAINED FROM THE USE OF THE 
SERVICE WILL BE ACCURATE OR RELIABLE, AND (iv) ANY ERRORS IN THE 
SOFTWARE WILL BE CORRECTED. 
ANY MATERIAL DOWNLOADED OR OTHERWISE OBTAINED THROUGH THE USE OF THE 
SERVICE IS DONE AT YOUR OWN DISCRETION AND RISK AND THAT YOU WILL BE 
SOLELY RESPONSIBLE FOR ANY DAMAGE TO YOUR COMPUTER SYSTEM OR LOSS OF 
DATA THAT RESULTS FROM THE DOWNLOAD OF ANY SUCH MATERIAL. 

NO ADVICE OR INFORMATION, WHETHER ORAL OR WRITTEN, OBTAINED BY YOU FROM 
4THERAPY.COM NETWORK OR THROUGH OR FROM THE SERVICE SHALL CREATE ANY 
WARRANTY NOT EXPRESSLY STATED IN THE AGREEMENT. 


17. Limitation of Liability 
YOU EXPRESSLY UNDERSTAND AND AGREE THAT 4THERAPY.COM NETWORK SHALL NOT 
BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL 
OR EXEMPLARY DAMAGES, INCLUDING BUT NOT LIMITED TO, DAMAGES FOR LOSS OF 
PROFITS, GOODWILL, USE DATA OR OTHER INTANGIBLE LOSSES (EVEN IF 
4THERAPY.COM NETWORK HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH 
DAMAGES), RESULTING FROM: (i) THE USE OR THE INABILITY TO USE THE 
SERVICE; (ii) UNAUTHORIZED ACCESS TO OR ALTERATION OF YOUR TRANSMISSIONS
 OR DATA; (iii) STATEMENTS OR CONDUCT OF ANY THIRD PARTY ON THE SERVICE;
 OR (iv) ANY OTHER MATTER RELATING TO THE SERVICE. 


18. Exclusions and Limitations 
SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OF CERTAIN WARRANTIES OR 
THE LIMITATION OR EXCLUSION OF LIABILITY FOR INCIDENTAL OR CONSEQUENTIAL
 DAMAGES. ACCORDINGLY, SOME OF THE ABOVE LIMITATIONS OF SECTIONS 13 AND 
14 MAY NOT APPLY TO YOU. 


19. Notice 
You agree that any notices of change to the Agreement or other matters 
may be made to you by displaying notices or links to notices to you 
generally on the Service or be made via e-mail. 


20. Trademark Information 
4therapy.com NETWORK is a trademark of 4therapy.com NETWORK (the 
"4therapy.com NETWORK Marks"). Without prior permission of  4therapy.com
 NETWORK, you agree not to display or use in any manner, the 
4therapy.com NETWORK Marks.  All other servicemarks and trademarks 
appearing on the website belong to their respective owners.


21. Links to Other Sites 
4therapy.com NETWORK contains links to other websites, sometimes called 
"third party" websites. These links are provided solely as a convenience
 to you and not as an endorsement by 4therapy.com NETWORK of the content
 on such third party websites. 4therapy.com NETWORK is not responsible 
for the content of linked third party sites and does not make any 
representations regarding the content or accuracy of materials on such 
third party websites. If you decide to access these third party 
websites, you do so at your own risk.


22. Advertisements 
4therapy.com NETWORK contains advertisements by third parties, and these
 advertisements may contain links to other websites. Unless otherwise 
specifically stated, 4therapy.com NETWORK does not endorse any product 
or make any representation regarding the content or accuracy of any 
materials contained in, or linked to, any advertisement on 4therapy.com 
NETWORK. 


23. Arbitration 
You and 4therapy.com NETWORK agree that any claim, dispute or 
controversy between us or claim by either of us against the other or the
 employees, agents or assigns of the other and any claim arising from or
 relating to this Agreement or the Service, no matter against whom made,
 including the applicability of this arbitration clause and the validity
 of this Agreement shall be resolved by neutral binding arbitration 
conducted in accordance with the rules of the American Arbitration 
Association.  Each such arbitration shall be conducted in Los Angeles, 
California and any arbitral award may be interpreted and enforced by any
 court of competent jurisdiction located in Los Angeles, California.  
The terms and conditions of this Agreement, including without limitation
 this arbitration provision, shall be interpreted by the internal laws 
of the State of California.  
This Agreement is made pursuant to a transaction involving interstate 
commerce, and shall be governed by the Federal Arbitration Act, 9 U.S.C.
 ?? 1-16. Judgment upon the aware may be entered in any court having 
jurisdiction. 

YOU AND 4therapy.com NETWORK UNDERSTAND THAT EACH WOULD HAVE HAD A RIGHT
 OR OPPORTUNITY TO LITIGATE DISPUTES THROUGH A COURT AND TO HAVE A JUDGE
 OR JURY DECIDE THEIR CASE, BUT EACH CHOOSE TO HAVE ANY DISPUTES DECIDED
 THROUGH ARBITRATION. 


24. Other Terms
The Agreement constitutes the entire agreement between you and 
4therapy.com NETWORK and governs your use of the Service, superceding 
any prior agreements between you and 4therapy.com NETWORK.

You also may be subject to additional terms and conditions that may 
apply when you use affiliate services, third-party content or 
third-party software.

The Agreement and the related relationship between you and 4therapy.com 
NETWORK shall be governed by the laws of the State of California without
 regard to its conflict of law provisions. 

The failure of 4therapy.com NETWORK to exercise or enforce any right or 
provision of the Agreement shall not constitute a waiver of such right 
or provision. 

If any provision of the Agreement is found by a court of competent 
jurisdiction to be invalid, the parties nevertheless agree that the 
court should endeavor to give effect to the parties' intentions as 
reflected in the provision, and the other provisions of the Agreement 
remain in full force and effect. 

You agree that regardless of any statute or law to the contrary, any 
claim or cause of action arising out of or related to use of the Service
 or the Agreement must be filed within one (1) year after such claim or 
cause of action arose or be forever barred. 

The section titles in the Agreement are for convenience only and have no
 legal or contractual effect. 

The printed version of this Agreement and any notice or amendment given 
in electronic form will be admissible in judicial or administrative 
proceedings based on or relating to this Agreement to the same extent 
and subject to the same conditions as other business documents and 
records originally generated and maintained in printed form.
By clicking on the following button labeled "I agree," you accept and 
agree to the terms of this Agreement.  
   
(c) 2001 4therapy.com NETWORK, Inc.

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