First Name* (required)
Last Name* (required)
Email Address* (required)
Phone Number*
Professional Title* (e.g., "Clinical Psychologist", "Health Coach")
Organization/Practice Name*
Service Classification* ClinicalNon-Clinical
Focus Areas* (Select all that apply) Trauma RecoveryChronic IllnessMental HealthNutrition & WellnessMind-Body IntegrationSomatic TherapyOther
Bio Sketch* (Brief professional biography - max 500 words)
Profile Photo (JPG, PNG - max 2MB)
By submitting this form, I confirm that: (i) The information you provide is accurate to the best of your knowledge. (ii) You give permission to the Viktor Frankl Institute to publish your name, mini bio, photo, country/city, and service categories on the Institute’s public practitioner directory. (iii)You understand that you are responsible for maintaining appropriate professional credentials and licenses in your jurisdiction and for the services you offer. I have read and agree to the above statement, and I consent to the publication of my information in the practitioner directory.
