Name
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First Name
Last Name
Email
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Phone
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(###)
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Professional Title and Discipline
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Qualifications
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Have you completed at least 100 hours of PAT-specific core training?
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Confirm your training covered the following outcomes
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Upload required: PAT core training certificates OR letter of endorsement from training provider
Do you have at least two years of clinical therapy experience?
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Have you completed at least 40 hours of experiential training?
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Have you facilitated two or more dosing sessions as part of your training?
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Have you completed a minimum of 6 hours of supervision with a PAT-experienced supervisor?
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Are you currently registered with a professional body?
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Do you have formal training in any of the following?
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Checkbox
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List your training and experience in culturally-informed healing practices:
Please describe your connection to community and cultural healing practice.
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Do you commit to:
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