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Provider Alliance Directory:
Become a Featured Provider

We’re so glad you’re here.

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This form allows us to spotlight your work in our provider directory and feature you in our community and newsletter.

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Take your time... your words matter here.

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This is your space to share not just what you do, but who you are.

(Please write in first person, we want to connect with our families directly from our heart.)

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Become a Featured Provider...

Let’s share your work with the families who need you.

How do you work?
If in-person, where do you see clients? (office, home visits, clinic, etc)
SPECIALTIES (FOR FILTERS) (Checkbox style if possible)
Do you accept insurance?
Yes
No
Do you offer private pay / cash pay?
Yes
No
Do you offer sliding scale options?
Yes
No
Are you currently accepting new clients?
Are you open to being featured in our newsletter or social media?
Yes
No
Do you give permission for your information to be displayed in the Jacob’s Ladder Provider Directory
Yes
No

Once you complete the full profile form, you’ll be included as a Featured Provider in our directory and eligible for spotlight features in our newsletter and community.”

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