CLINICIANS IN COMMUNITY ENROLLMENT

By joining CIC, you will be given access to various synchronous and asynchronous community spaces to connect with with other licensed therapists. It is your responsibility to understand the protections and limitations of these platforms and engage in them responsibility and ethically.

Name

Email Address

What do you hope to get out of increasing your clinical community?

What type of professional license do you hold and in what state? Please include active license number and link to your Board license lookup.

Acknowledgement and Agreement

Please check the boxes below to confirm your agreement with group requirements:

1. While any consultation meetings will be generated through a HIPAA compliant account, you understand that it is your responsibility to abide by your professional code of ethics regarding disclosing client information and protecting privacy. Discord is NOT HIPAA compliant and therefore should not be used for formal consultation purposes.

2. You understand that all personal information shared within CIC, whether about a client or a provider, is to be held in confidence and not discussed outside of the group.

3. This is a professional space for independently licensed mental health clinicians and is not currently open to anyone unlicensed or under supervision. This is for liability purposes and is why any new members must be directed to enroll and undergo a license verification.

4. You are aware that this is a collaborative group that provides peer support and is not a space for personal therapeutic processing. You understand that consultation is distinctly separate from psychotherapy and all members are advised to seek their own therapist for support as is necessary to support their own mental health.

5. Should something change about your current clinical status (complaint against your license, disciplinary action with employer, claim filed against liability insurance, criminal charge reportable to Board, etc), you need to inform me directly in order to determine your eligibility to continue in the consultation group.

6. All aspects of this community space are grounded in curiosity, inclusivity, kindness, equity, and compassion. In order to ensure this group remains a safe space for all members to engage authentically with one another, you understand that respect for the diversity of life experiences, perspectives, and knowledge of our group is paramount.

7. I understand that I will not be added to any mailing lists outside of Clinicians in Community and that my email address will be visible to all other members when live meeting reminders are sent out. Reminders will only be sent for bi-weekly consultation, monthly lunch & learn events, and the rare announcement/update needing to be communicated to the group.

Thank you for enrolling in our Clinicians in Community Group. You will be added to the zoom group once your license has been verified. If you need to contact me before our next consultation group, you can reach me at info@meaganfaraonelcsw.com.