Create Your PsychScan Pro Account

Contact Name*
Contact Email*

Practice Name*

example: Jane Smith, LCSW
example: Springfield Counseling

Subscription*
  Monthly
  Annual


Your Website
This is the webpage clients will return to after completing a PsychScan assessment

example: www.mywebsite.com
Your Profession*
Do you hold a current, valid license in your mental health profession?*


Contact information to include on Client Report

This information will appear on the Client Report so prospective clients know how to reach you.

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

*required