PCIT Inquiry Form

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PCIT Inquiry Form

Thank you for your interest in using Google Workspace to improve your PCIT practice.

Please fill out the form below to provide information about you and your specific needs.

After submitting the form, you will have the option to schedule a meeting with me.

Your Name *

Email *

Practice or Business Name

Occupation

Social Worker

Marriage & Family Therapist

Counselor

Psychologist

Autre :

Which of the following elements are you interested in including in your plan?

📈 WACB-P

📉 WACB-N

📈 PSICA

📊 Days of Special Time

❓ General PCIT Strategies

❓ Specific PCIT Strategies

❓ PC-CARE Strategies

👥 Group Tracking Option

👥 Multiple Therapist Option

💻 Ongoing Tech Support

Autre :

Briefly describe any other specific needs related to your practice.

Do you have a paid Google Workspace plan, and have you signed the Business Associate Agreement (BAA)?

A paid Google Workspace plan with a signed BAA are required to ensure HIPAA compliance.

For more information about the Business Associate Agreement (BAA), please see my website.

Yes, and yes

Yes, and not yet

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Please rate your level of expertise with Google Workspace (Forms, Sheets, Drive).

Beginner

Expert

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