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Become a Provider

Apply to be a Mental Health Partner

Complete and sign the form below to be considered to be a mental health partner with Everyone's Healing.

First name

Last name

Phone

What states are you licensed to practice mental health services in? Check all that apply.

Illinois

Missouri

Other

I am able to provide the following types of services, (If you can provide in person services please list the physical location in the Other section below.)

In person

Virtual

Other

Why is it important for you to work with Everyone's Healing? (150 to 200 words)

Is there anything else you would like us to know about you? (Ex: I love stand up paddle boarding with my dog on the weekends ;-)

Everyone’s Healing

Mental Health Provider Application & Authorization Agreement

Thank you for your interest in providing mental health services through Everyone’s Healing, a nonprofit committed to expanding access to compassionate, equitable, and culturally responsive mental healthcare.

By submitting this application, I acknowledge and agree to the following:

Commitment to Inclusive and Equitable Care

I agree to provide care that is respectful, compassionate, and affirming of each client’s identity, lived experience, and individual needs. I commit to providing:

Anti-racist care that recognizes and works to address the impact of racism, discrimination, and systemic inequities on mental health and access to care.
Anti-ableist care that respects the dignity, autonomy, and diverse abilities of clients and works to reduce barriers for people with disabilities.
LGBTQ+ affirming care that respects and affirms clients of all sexual orientations, gender identities, and gender expressions.
Trauma-informed and culturally responsive care that supports clients without judgment or discrimination.

I understand that Everyone’s Healing seeks to connect community members with providers who share these commitments and who are dedicated to creating a safe and welcoming therapeutic environment.

Immigration Status

I understand and agree that Everyone’s Healing does not inquire about, collect, or require clients to disclose their immigration status as a condition of accessing services through the organization.

Professional Responsibilities

I agree to provide services in accordance with applicable professional standards, ethical requirements, licensing regulations, and the terms established by Everyone’s Healing.

I understand that submitting this application does not guarantee approval to provide services through Everyone’s Healing. Provider participation is subject to application review, verification of credentials and licensure, and any additional requirements established by Everyone’s Healing.

By submitting this application, I confirm that the information I have provided is accurate and that I agree to uphold the values and commitments described above.

Signature

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If you are an independently licensed clinician or represent an agency that would like to partner with Everyone's Healing and provide therapy services, please complete the form below.