ACCESS TO MENTAL HEALTH SERVICES

FOR URBAN NATIVES

REGARDLESS OF RECOGNITION STATUS

Looking for an Indigenous therapist?

Create your connection appointment today!

🚀 Participants start with a welcome session with CEO & Co-Founder Austin Serio

participant signup

ShockTalk Pilot | Provider Sign Up

Name

First Name

Last Name

What's the best way for us to reach out to you?

Phone

(###)

###

####

Who recommended ShockTalk?

Indigenous Affiliation

Please include Indigenous cultural affiliation(s), or Tribal affiliation(s). We recognize all Indigenous peoples, regardless of State or Federal status.

Do have an active clinical/professional/therapeutic/medical license?

Yes

State

Are you licensed in more than 1 state? If so, which states? If not, please respond N/A.

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