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Practice Type*  ←Select this first.
Professional Title*
Email*
 Will not be shown on your profile.
Retype Email*
Create Password*  (at least 5 chars)
First Name*
Last Name*
Designations  E.g. MSW, LMT.  chars left
Practice Name   chars left
Leave this blank if you don't use a practice name. Don't repeat your own name here.
Headline 1*   chars left
Headline 2   chars left
Profile Display*
Contact Me By*
Profile URL* SpeechTherapyNext.com/Profile/   chars left
Choose your personalized profile page URL here. Keep it meaningful and simple (i.e. /YourName).
Must contain only alphanumeric characters (a-z and/or 0-9) and "_" or "-" instead of spaces.
Example: If you enter JohnSmith your profile URL will be: speechtherapynext.com/Profile/JohnSmith
Address  If you are a mobile practice, leave this blank.
Suite/Apt #
City*
State/Country*
Zip/Postal Code*  Only use 5 chars for U.S. zip codes.
Phone*  Will not show on your profile if you choose "Clients Can Contact Me by Email Only" above.
Alt. Address
Alt. Suite/Apt #
Alt. City
Alt. State/Country
Alt. Zip/Postal Code  Only use 5 chars for U.S. zip codes.
Alt. Phone
Website  E.g. www.mysite.com
Hours
Fees  Sometimes it's best to leave this blank and discuss fees on the phone.
Payments Accepted
 chars left
License Info
About*
300 chars min.
 chars left
Bio
 chars left
Education/Training
 chars left
Memberships/
Associations
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Other Languages
Recommendations If checked, your profile can display recommendations. You can approve or delete any recommendations.
Practice Areas/Issues Treated*
Certifications*
Helpful links (URLs) for potential clients.
• All links (URLs) must have descriptions.
Link #1   chars left
E.g., http://yahoo.com/somepage
Link #1 Description   chars left
E.g., Useful information about some topic.
Link #2   chars left
Link #2 Description   chars left
Link #3   chars left
Link #3 Description   chars left
Link #4   chars left
Link #4 Description   chars left
Link #5   chars left
Link #5 Description   chars left
I am not a robot*
Terms* I agree to the Professional User Agreement and Terms of Service
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