Apply to the Kyan Health Network

Personal Information

Tell us how to reach you

First name *

First name is required

Last name *

Last name is required

Email *

Valid email is required

Phone number *

Phone number is required

City *

City is required

State / Region *

State / region is required

Country *

Country is required

Languages spoken *

Please list the languages you practice in

Help us verify your qualifications

Association or licensing body

Include your credential type if applicable (e.g. LCSW, PsyD, ICF-PCC).

License / registration number

Country of licensing *

Country of licensing is required

Upload your highest degree or accreditation certificate

PDF, JPG, PNG, DOC, or DOCX — max 10 MB

Upload your professional license

PDF, JPG, PNG, DOC, or DOCX — max 10 MB

Upload your CV / résumé *

PDF, DOC, or DOCX preferred — max 10 MB

Please attach your CV / résumé

A few more questions before you submit

Hourly session rate

Currency

Referred by

Are you self-employed / working as an independent contractor? *

Yes No

Do you have professional indemnity insurance? *

Yes No