Name * First and last name as professionally registered First Name Last Name Email * Phone (###) ### #### Brief Bio * 2–4 sentence summary highlighting background, experience, and therapeutic approach Accreditation Category Psychedelic-Assisted Therapist (PAT) Psychedelic Facilitator (PF) Psychedelic Prescriber (PP) Registration Numbers * e.g. AHPRA, PACFA, ACA, Medical Board Accreditation Status Fully Accredited Provisionally Accredited Website or booking link http:// Practice/clinic Location Address 1 Address 2 City State/Province Zip/Postal Code Country Languages Spoken If relevant for accessibility Professional Registrations AHPRA PACFA / ACA AASW Other (please specify) Clinical & Therapeutic Focus Areas Trauma & PTSD / Complex Trauma Depression & Mood Disorders Anxiety, Panic & OCD Addiction & Substance Use Grief & Bereavement Eating Disorders Personality Disorders (BPD, NPD) Neurodivergence (ADHD, Autism, Sensory) End-of-Life & Palliative Support Spiritual Emergence / Psychosis Risk Youth, Adolescents & Families Couples & Relationship Therapy Other (please specify) Therapeutic Modalities / Approaches Preparation for Psychedelic Therapy Psychedelic Integration Harm Reduction EMDR Internal Family Systems (IFS) Cognitive Behavioural Therapy (CBT) Somatic Experiencing (SE) Sensorimotor Psychotherapy Polyvagal-Informed Therapy Narrative Therapy Art Therapy Music Therapy / Sound Healing Dance / Movement Therapy Breathwork Facilitation (e.g., Holotropic) Yoga-Based Therapy Meditation / Mindfulness Practices Dreamwork & Symbolic Integration Other (please specify) Cultural & Spiritual Frameworks First Nations Mental Health / Cultural Consultancy Faith-Based / Religious Mental Health Practice Ceremony Preparation & Integration End-of-Life Integration & Legacy Work Intergenerational Trauma / Ancestral Psychology Other (please specify) Additional Services Group Therapy or Facilitation Supervision / Mentoring Online / Telehealth Rural / Remote Support Multilingual Services Other (please specify) Thank you!
