Welcome, Human 🌸

We are deeply grateful that you have chosen to walk this path with us.

Your presence here speaks to your heart's calling to help others heal. This application is a gentle beginning — a space for you to share your story, your gifts, and your journey. We honor the courage it takes to show up, and we want to make this experience as nurturing as possible for you.

⏰

Take Your Time

About 15-20 minutes

💧

Stay Hydrated

Keep water nearby

📁

Documents Ready

Certificates & photo

Your progress is gently saved as you go. There is no rush — breathe, take breaks, and return whenever you feel ready. 💫

Personal Information

Full Name *

Email Address *

Phone Number *

Date of Birth

Gender

Pronouns

State *

City *

Pincode

Professional Information

Services Information

Additional Information

Professional Bio *

Therapeutic Approach *

Achievements & Certifications

Professional References

Please provide at least one professional reference who can vouch for your work. This helps us maintain the quality and trust of our community.

Reference 1 (Required) *

Full Name *

Relationship *

Phone Number *

Email Address *

Reference 2 (Optional)

Full Name

Relationship

Phone Number

Email Address

Terms & Agreements

I agree to the Terms of Service and Privacy Policy. I confirm that all information provided is accurate and I am a licensed mental health professional. *

I authorize MindBridge India to store, process, and use my information for the purpose of connecting me with potential clients and improving platform services. I understand my data will be handled securely and in accordance with applicable data protection laws. *

I consent to MindBridge India verifying my credentials, including contacting my references and verifying my professional licenses and certifications. *

I agree to abide by MindBridge India's Code of Conduct and Professional Ethics Guidelines, maintaining the highest standards of care and confidentiality with all clients. *

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