Interest Form

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Interest Form

Better Together Live is an interview series that highlights local resources to build awareness and connection so we can support one another and our community when it matters most.

Each 15-minute interview will be hosted by Lauren Furtado, the Community Relations Coordinator at TherapyWorks. Guests are given the opportunity to introduce themselves and the services offered by their practice or organization. The interview will be scheduled and pre-recorded using the Zoom video platform.

Following the interview, the episode will be shared with TherapyWorks' online community to help extend our support.

If you are interested, please complete the following form to ensure a good fit.

Name: *

Practice / Organization Name: *

Email: *

Phone: *

Website: *

Briefly describe your practice / organization: *

Describe the type of client(s) you typically support: *

Describe any clinical or diagnostic speciality you have: *

Would you be interested in sharing the interview with your community for promotional and marketing purposes? *

Yes

Maybe

Would you give permission to TherapyWorks to repurpose the interview for promotional and marketing purposes? *

Yes

Maybe

Are you / your organization on Facebook? Please provide your handle

Are you / your organization on Instagram? Please provide your handle

Is there anything else you would like to share?

Thank you!

We appreciate your interest and will be in touch soon.

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