Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

Therapist Form by Z4Rv5z

VIEWS: 5 PAGES: 8

									                                   Bio-Medical Instruments Inc.
                                   2387 East Eight Mile Road
                                   Warren, MI 48091-2486
                                   Phone: 586-756-5070 Fax: 586-756-9891


                      Public Listing Information

Title                                         * Required Fields                Email the form along with
                                                                               your logo, your practice o
First Name                                                                *    medical.com
Middle

Last                                                                      *
Company Name

Address                                                                   *
Adress 2

City                                                                      *
State                                                                     *
Zip                                                                       *
Business Phone                                                            *
Fax

Email

Contact Methods                 Phone           Email        Fax
Website

Practicing Since

Average cost per session           $
Accept Insurance?                       Yes             No
Introduction Paragraph:




                      Private Information (if different from public listing)
Title
First Name

Middle

Last

Address

Adress 2

City

State

Zip

Business Phone

Fax

Email


MARK ALL THAT APPLY WITH AN X:
       Academic                          Licensing
      Bachelor of Science in Education   Certified Clinical Social Worker
      Bachelor of Science in Nursing     Clinical Psychologist
      Doctor of Chiropractics            Clinical Social Worker
      Doctor of Dental Surgery           Family and Child Counselor
      Doctor of Education                Licensed Clinical Psychologist
      Doctor of Medicine                 Licensed Clinical Social Worker
      Doctor of Optometry                Licensed Graduate Social Worker
      Doctor of Osteopathy               Licensed Independent Clinical Social Worker
      Doctor of Philosophy               Licensed Marriage and Family Counselor
      Doctor of Psychology (PhD)         Licensed Marriage and Family Therapist
      Doctor of Psychology (PsyD)        Licensed Marriage, Family and Child Counselor
      Doctor of Science                  Licensed Mental Health Counselor
      Doctor of Social Work              Licensed Mental Health Services
      Master of Arts                     Licensed Professional Counselor
      Master of Counseling               Licensed Psychological Associate
      Master of Education                Licensed Psychological Examiner
      Master of Science                  Licensed School Psychologist
      Master of Science in Nursing       Licensed Social Worker
      Master of Science in Social Work   Marriage and Family Counselor
      Master of Social Science           Marriage, Family and Child Therapist
      Master of Social Work              Psychological Associate
      Phd Candidate                      Registered Independent Social Worker
Registered Nurse                                                    Social Worker

                                                                             Affiliations
Certification                                                                AAPB Member
Academy of Clinical Social Workers                                           American Nursing Association
Advanced Clinical Practitioner                                               BCIA Certified
American Association for Marriage and Family Therapy                         BCIA Mentor
American Association of Professional Hypnotherapists                         Clinical Supervision (remote training)
American Board of Examiners in Clinical Social Work                          Educator
American Board of Family Psychology                                          In House Clinical Supervision
American Board of Medical Psychotherapy                                      ISNR Member
American Board of Psychological Hypnosis                                     Researcher
BCIA Certified in Biofeedback
BCIA Certified in Neurofeedback
BCIA-Certified in Pelvic Muscle Dysfunction Biofeedback
Board Certified Diplomate in Clinical Social Work
Board Certified in Child and Adolescent Psychology
Board Certified in Clinical Social Work
Certified Alcohol and Drug Counselor
Certified Clinical Mental Health Counselor
Certified Family Nurse Practitioner
Certified Independent Social Worker
Certified Marriage and Family Therapist
Clinical Specialist in Adult Psychiatric and Mental Health Nursing
Diplomate, American Academy of Behavioral Medicine
Diplomate, American Board of Psychiatry and Neurology
Diplomate, International Academy of Behavioral Medicine, Counseling and Psychology
Diplomate, Neuropsychiatry
National Academy of Mental Health Counselors
National Board of Certified Counselors
National Certified Counselor
National Register of Health Services Providers in Psychology
QEEG Technician
QEEG-Diplomate
Registered Health Care Provider


Modalities
ECG
EEG
EMG
Ergonomics
GSR
Heart Rate
Heart Rate Variability
HEG
    Incontinence
    Oximetry
    Qeeg
    Respiration
    Stimulation
    Temperature

    Specialties                                                                   Irritable Bowel Syndrome
    Addiction                                                                     Knee Pain
    Anger Management                                                              Lower Back Pain
    Anxiety                                                                       Mood Disorders
    Arthritis                                                                     Myofascial Pain
    Aspergers                                                                     Neuromuscular Rehab
    Asthma                                                                        Pain Management
    Attention Deficit Disorder/Hyperactivity Disorder                             Parkinson's and Movement Disorders
    Autistic Spectrum Disorders                                                   Peak Performance & Sports Applications
    Breathing Problems                                                            Phantom Limb Pain
    Chest pain                                                                    Post Traumatic Stress Disorder
    Chronic Disease Management                                                    Posture Related Pain
    Chronic Pain                                                                  QEEG Assessment
    Closed Head Injury                                                            Raynaud's Syndrome
    Conduct and Attachment Disorders                                              Rehab
    Constipation                                                                  Sleep Disorders
    Depression                                                                    Smoking Cessation
    Developmental Disorders                                                       Spinal Cord Injury
    Dysphagia                                                                     Stress Management
    Epilepsy and Seizure                                                          Stress Management for Children
    Fecal Incontinence                                                            Stump Pain
    Fibromyalgia                                                                  Substance Abuse
    Geriatric                                                                     Temporomandibular Disorder
    Headaches                                                                     Tinnitus
    Hypertension                                                                  Traumatic Brain Injury
    Hyperventilation                                                              Urinary Incontinence
    Interstitial Cystitis

                                                 Acceptance
I agree to allow Bio-medical Instruments, Inc. to use the above information for publishing in a public online directory listing. A
the information above is true and accurate to the best of my knowledge. Bio-medical Instruments, Inc assumes no responsibi
incorrect or inaccurate information. Please check the box below. Thank you.


                                                        I have read the acceptance and agree.
mail the form along with a large image of yourself,
our logo, your practice or your staff to brian@bio-
 edical.com




                                                  NEVADA




                               *
nical Social Worker
 mily Counselor
 mily Therapist
y and Child Counselor




Social Worker
ng Association


ion (remote training)

l Supervision




            Equipment Used
            Alpha Stim
            Brainmaster
            Brainquiry
            BrainTrain
            Cygnet
            Deymed
            Heartmath
            IVA
            J&J
            LENS
            Mind Alive
            Mitsar
            Neuroguide
            Nexus
            SKIL
            Thought Technology
            TOVA
nt Disorders
rts Applications




nline directory listing. All of
assumes no responsibility for

								
To top