As Amudim prides itself on maintaining the most up to date information so we can best serve our clients, we ask that you please complete this form, so that we can keep our database as up to date as possible. 

Question for Private Therapist
Therapist Certification with the Month and Year of Certification
Are there other therapists in your practice?

Program Location:

Primary Contact Person information:

For Amudim Internal Use Only

Please enter information about your program:

Genders Served
Is this program LGBTQ+ friendly?
Services Offered:
Age of clients served
What languages do you provide services for
Areas addressed (select all that apply)
Please select the modalities you or other therapists in your practice are trained in:

Cost of treatment in USD

Cost of Intake in USD (if applicable)

Do you accept insurance?
Are you exclusively private pay?
How is your insurance billed?
Do you provide a Superbill for out of network reimbursement?
Do you offer a sliding scale?
Does your program offer a standard discount for Amudim clients
Do you assist clients in obtaining Single Case Agreements from their insurance?
Do you offer scholarships?