Become an Affiliate : Careers : Get Involved : Pastoral Institute

Practicing licensed therapists have the opportunity to contract as affiliate providers with the Pastoral Institute and serve clients from our 70+ Employee Assistance Program partners across Georgia. By becoming an affiliate provider, the clients come to you as we partner to support a healthy workforce in our state! Please submit the following interest form to learn more.

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Name

First Name *

Last Name *

Phone

Mailing Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

City & County Where You Currently Practice

Credentials

Specialties or Preferred Modalities

What Age Clients Will You Accept?

Please provide your standard (self-pay) hourly service rate and the rate you would be willing to accept to service our Affiliate referral clients

Become an Affiliate

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