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Home > List Your Practice > Standard Profile Example > Standard Profile Registration Form

Standard Profile Registration Form

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Creating Your Standard Profile

 
Below is the form for entering your information for a Standard Profile. Before starting, we recommend that you take a little time to prepare your material.
 

First, go to the Standard Profile Example to familiarise yourself with the format and the various sections. It is not compulsory to provide information for all sections, so decide which ones are relevant to you, and then gather the information needed.

You can either type your details directly into each field, or you may prefer to prepare your text in Word and then copy and paste it into the form. Some sections have a character limit, which is indicated beside the field names below, when you reach the character limit you will not be able to add more text to that field (you will be able to edit the text you have entered).
 
At the bottom of the form is a button for uploading your image. Most people choose to use a photo of themselves, however you are also welcome to use another image such as a logo, a photo of your building, or some other symbolic image you like. We recommend that you use photos with good resolution, and if it is a photo of you preferably one taken recently.
 

If you have any questions or need assistance, don't hesitate to contact us.
 
PROFILE INFORMATION to be seen by clients
Profile Name*
Select your Professional Title/s
Counsellor
Psychotherapist
Psychologist
Career Counsellor
Family Therapist
Child Therapist
Arts Therapist
Christian Counsellor
Life Coach
Supervisor
Practice Name
Profile Introduction (300 characters)
Phone
Mobile
Email
Website, if you have one you want a link to.
Practice Address One
Practice Address Two
Practice Address Three
Do you provide ONLINE counselling/therapy
Client Types
Children
Girls
Boys
Adolescents
Adolescent girls
Adolescent boys
Adults
Adult women
Adult men
Couples
Families
Groups
Counselling Specialties (250 char)
COUNSELLING / THERAPY SERVICES (1250 char) - potential clients are especially interested to know about the benefits of seeing you, what will change for them. It is important to describe this in language your target clients will understand, so think about how they describe their issues and change they are looking for.
Counselling/Therapy Approach (750 char)
Professional Registrations
Registered Psychotherapist
Registered Psychologist
Registered Clinical Psychologist
Registered Counselling Psychologist
ACC Registered Counsellor
Family Court Registered Counsellor
Victim Support Registered Counsellor
Any other registrations?
Professional Association Memberships
Member New Zealand Association of Psychotherapists (MNZAP)
Provisional Member New Zealand Association of Psychotherapists (ProvMNZAP)
Member New Zealand Association of Counsellors (MNZAC)
Provisional Member New Zealand Association of Counsellors (ProvMNZAC)
Member NZ Psychological Society (MNZPsS)
Member NZ College of Clinical Psychologists (MNZCCP)
Practitioner Member of the Drug and Alcohol Practitioners Association of Aotearoa-New Zealand (DAPAANZ)
Professional Member of the Career Development Association of NZ (PMCDANZ)
Professional Member of the Australian, New Zealand and Asian Arts Therapy Association (MANZACATA)
Member NZ Christian Counsellors Association (MNZCCA)
Any other Professional Memberships?
Qualifications
BACKGROUND & EXPERIENCE - info here helps to assure potential clients you are experienced and skilled (750 char)
SUPERVISION SERVICES describe the supervision services you provide (max 1250 char)
APPOINTMENTS - describe your availability especially if you provide evening or weekend appointments (250 characters)
FEES - include info about your access to third party funders and surcharges (250 characters)
Payment Options (250 characters)
TRANSPORT & PARKING (250 characters) - important if you work in an area known for parking problems.
Languages other than English (250 characters)
ATTACH THE PHOTO or IMAGE for your Profile
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The INFORMATION below is for Administrative purposes only. It will NOT be seen by clients.
First Name*
Last Name*
Name for Invoice if different from your name
Preferred email for us to contact you*
Preferred phone for us to contact you*
Postal Address*
In order to assist us in reducing spam, please type the characters you see:
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After you click the SEND button you will be taken to a new page.
If you have clicked the SEND button and you are still on this page there is an error in your form.
Please scroll up to find the error message and correct it.
Then click the SEND button again.