SITT Therapist RegistryRequest Edits to Your Registry Entry Please enable JavaScript in your browser to complete this form.InstructionsRemoval: If you are requesting your listing to be removed, simply select the option for “Remove My Listing,” enter your name, and then check the Confirm & Consent at the bottom.Edits: If you are requesting specific edits to parts of your listing, select the “Edit My Listing” option. Then fill out your name and only the other relevant sections of the form where you want to make changes. Then Confirm & Consent at the bottom.Changes will be verified before being posted.Name *FirstLastThis field is for identification and communication. The name, as you want listed on the registry, is below.Email *This email address is for communication regarding your listing, and will not be posted on the registry. If you want an email listed on the registry, enter that in the field below.Type of Edit Requested: *Remove my listing.Edit my listing as follows.Full Name, including credentials you want listed. *i.e., Amanda Lee, LCSW. Note that there isn’t space for a long list of credentials, so pick what matters most. Also, you do not need to list SITT here, since all therapists on the registry are either trained or certified in SITT.City and Statei.e., Portland, OregonRegionHow do folks who live where you live describe your geographic region? For example, the Pacific Northwest, or the Gulf Coast. This is used to subdivide the registry into geographic regions.Practice DescriptionWrite a brief description, up to 170 characters, to help prospective clients quickly determine if you might be a potential match for their needs.Example descriptions:“Specializing in trauma care, PTSD, and CPTSD. EMDR trained. Licensed in NC and SC. Christian provider. Accepts some insurance.”“I can help you develop and restore healthy relationships. Process and overcome trauma, bringing healing & happiness back into your life.”“I work with survivors of trauma, complex grief, and somatic symptoms. My modalities include EMDR, Sandtray, and CPT. Holistic care that brings sustainable wellness.”Description *170 characters maximum.PhonePhone number listed on the public registry.EmailEmailConfirm EmailEmail address listed on the public registry.WebsiteWebsite of practice, listed on the public registry. Leave blank if you don’t have a website for your practice.Confirmation and Consent * Confirmation & Consent By checking the above box and submitting this form, you confirm that you are the above-listed person, or an authorized agent of that person. Further, you confirm that you are submitting changes for your Registry Listing, and you consent for us to verify these changes before making them.Submit42581