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Add a PsychScan link to your webpage or send the link to new or established clients by email or text. When a client completes the PsychScan assessment you receive a secure email to access the report. There’s no programming, we provide everything you need. With no charge for the first month, you can try PsychScan risk-free.

*required

First Name*

Last Name*

Email*

Practice Name*
e.g. Jane Smith, LCSW e.g. Springfield Counseling

Your Website
This is the webpage clients will return to after completing a PsychScan assessment If you do not provide a website URL, clients will be taken to Psych-Scan.com after completing a PsychScan assessment e.g. mywebsite.com

Your Profession*

If other, please describe

Do you hold a current, valid license? *

Yes
No

U.S state or region

Practice location if outside U.S.

Contact information to include on Client Report
This is how prospective clients will contact you
Include the contact information you want clients to see on the Client Report

e.g.
Jane Smith, LCSW
1234 Main St.
Springfield, IL 12345
janesmith@mail.com
www.yourwebsite.com

Terms of Use	X
Beta Test Program Terms and Conditions You are requesting enrollment in a beta test program for the purpose of testing and evaluating the PsychScan testing service (the “Service”). Participation in the beta test program is subject to the following term and conditions: The duration of the beta test period is determined by PsychScan at its sole discretion. Your participation in this program may be terminated by PsychScan at any time. In consideration for use of the Service, you agree to provide periodic feedback to PsychScan regarding your experience with the Service. The Service is not intended to diagnose, treat, cure, or prevent any medical or mental health disease or condition. Test results are not medical or mental health advice and are in no way to be interpreted as a substitute for a medical and/or mental health evaluation by an appropriately credentialed and licensed healthcare professional. PsychScan, LLC and its parents, subsidiaries and affiliate organizations, and all of their respective agents, employees, representatives, administrators, officials, members, attorneys, shareholders, officers, managers, directors, successors, assigns, and personal representatives (collectively, PsychScan, LLC), are not liable or responsible for any advice, finding, assessment results, or any other information, services or product you obtain through the Service. PsychScan, LLC shall not be liable for any DIRECT, INDIRECT, INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES, OR LOST PROFITS that result directly or indirectly or are related in any way to use of The Service. In consideration of your purely voluntary use of the Service, you hereby agree to waive any and all present and future claims against PsychScan which are in any way related to use of the Service including but not limited to claims, demands, and/or causes of action which allege negligent acts or omissions, or malpractice. In states which do not allow some or all of the above limitations of liability, liability shall be limited to the greatest extent allowed by law.
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