Please enter your details below and one of our team will be in touch with you soon.
This information will only be available to secure administrative areas and not for public viewing.

*Anonymous Username:
*Anonymous Password:
*Your First Name:
*Your Last Name:
*Your Telephone Number:
*Your E-mail Address:
*Address Line One:
Address Line Two:
Address Line Three:
*Town / City:
*Country (currently only the countries listed):
*Zip / Postal Code:
*Type of Practice:
*Years in Practice:
Please check your Speciality Areas:  Adolescents
   Coping with Change
   "Existential" issues (identity, meaning, death anxiety, etc.)
   General Anxiety
   Grief and Loss Counselling
   Marriage and Family
   Mood Disorders
   Obsessive Compulsive Disorder
   Post Traumatic Stress Disorder
   Relationship Counselling
   Sex Therapy
   Social Anxiety
   Stress Management
   Substance Abuse / Dependence
   Trauma Recovery
Do you have a Website Address?:
This will NOT be shown to the public. It is for vetting purposes only.
*Current Religious Affiliation:
Past Religious Affiliation (if no longer religious):
*What States are you Licensed in?:
*What is your main License?:  
*Would you be willing to undertake distance counselling?:
In what languages are you competent to do therapy?:
*Do you agree with the statement below?:
*Statement of Purpose. Please write a brief statement about your therapeeutic approach that would speak to potential clients:
Description of yourself you would like visible to the public:
Finally, it will help us make an informed decision if you can give us evidence that you use a largely secular approach to therapeutic practice or in your professional and non-professional life. Examples might be:
1. Active in a Unitarian Church, Ethical Society, atheist or humanist group.
2. Published professional papers, books or write a blog that illustrates secular values.
3. Work for an organization that generally is secular in nature - eg. Planned Parenthood, Americans United for Separation of Church and State.
4. Facebook page that shows secular values
5. Have a website that clearly shows secular values
6. Belong to FFRF, American Atheists, American Humanist Association, Atheist Alliance, or other clearly secular organization.

Statement of agreement:
"While you may or may not be religious or spiritual, you agree to use nothing but secular methods of therapy on clients referred by this service. This would preclude any use of spiritual or supernatural techniques such as prayer, past life regression, new age, anything that calls upon supernatural elements or any other therapeutic method not based on scientific research and best practices."


This service only attempts to match you with a therapist in your community. We provide no guarantees or assurances of quality or qualifications. It is important that you do your own research on their qualifications and reputation as well. Therapists in our database agree to use secular therapeutic methods only. They promise not to recommend prayer or other supernatural methods. While a therapist may be religious, they promise to keep their spiritual / religious ideas out of the therapeutic relationship.