Therapist / Ministry Application Form

Section 1 — Basic Information

Email

First name

Last name

Phone

Organization Name

Title

City

State

Website

Section 2 — Type of Services

Section 3 — Client Focus

Section 4 — Professional Background

Licenses / Certifications (if applicable)

Years of experience

Education or ministry training

Are you affiliated with a church or ministry?

Section 5 — Statement of Faith

Match Made in Therapy exists to connect people with Christ-centered healing resources.

Please briefly share your beliefs regarding:

• Jesus Christ

• Prayer and spiritual healing

• The role of faith in mental health

Section 6 — Alignment

Do you agree with the following?

✔ I affirm that Jesus Christ is Lord.

✔ I seek to provide Christ-centered care and guidance.

✔ I understand Match Made in Therapy may conduct an interview before listing partners.

Section 7 — Directory Listing

What services should appear in the directory?

Please list:

Short bio (2–4 sentences)

Services offered

Website link

Contact method for clients

Thank you!