If you have completed the full Basic conference and would like to be added to the Therapist Referral list, please complete the form below and submit along with a copy of your conference certificate (required). If you do not have a copy of your certificate, please request a copy from the host of the conference you attended.
Please note: Your information will be accessible online and provided to those requesting a referral in your area. Therefore, please make sure the contact information you include is the information you want to share with potential clients/patients. (Referrals lists are updated quarterly.)