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Therapist Referral Form

Request to Join Our Therapist Referral List


Are you a therapist who specializes in adoption trauma? We encourage you to join our group practice for comprehensive support, training, and direct billing opportunities.

We are also still accepting adoption-competent therapists for our referral network. If you prefer to remain in your independent practice and receive referrals, please complete this form and we will be in touch.

At On Your Feet, we work to connect our clients with adoption-competent therapists who understand the unique needs of birthparents. Your information will not be published and we will reach out to you first before making a referral.

Benefits of joining our group practice include:

  • Full credentialing support with major insurance plans (Medicaid to come)
  • Specialized training in adoption-competent care and PMAD treatment
  • Regular case consultation and ongoing support
  • Direct billing - no need to negotiate reduced rates
  • Connection to our network of adoption professionals

Learn more about joining our group practice →

Request to be added to our Therapist Referral List

First Name *
Last Name *
Do you offer sessions via Telehealth?
Country
Address Line 1 *
City *
State/Province *
Postal Code *

Additional Details

Would you like to be added to our mailing list to be informed of all adoption professional networking meetings, Activism in Adoption Sessions, plus stay current on all of our birthparent programming and services?
Thank you for recognizing the importance of post-placement support: