Mind Garden Therapy: Therapist Application

To apply for registration at Mind Garden, please complete the following application form.

    Membership body

    If other please specify

    Membership Number

    Code of Ethics to which you adhere

    Client groups served

    Post-qualification client hours to date

    What private insurance providers or similar are you registered with?

    When are you available to work at Mind Garden?

    • Morning
      9 - 12

    • Afternoon
      13 - 16

    • Evening
      17 - onwards

    First Name

    Last Name



    State / Province / Region

    Post Code



    Phone Number


    Qualifications WITH completion dates AND training organisation

    Clincal orientation (psychodynamic, integrative, etc.)

    Areas of specialisation

    Have you ever had a professional complaint upheld against you or been asked to leave a place of work?
    If yes please provide details

    Hours of supervision you have each month?

    Supervisor’s name

    Are you able to offer at least 10 hours a week
    (incl at least 1 evening) at Mind Garden?

    Supervisor’s email address

    Please describe your current work commitments elsewhere

    Why do you want to work at Mind Garden?

    Hours of supervision you have each month?

    How do you plan to build your practice?

    Working at Mind Garden requires regular use of an online room booking system, online calendar, and email communication. Please indicate your level of confidence in being able to independently utilise these facilities.

    Are you currently in personal therapy?

    Total hours of personal therapy

    How did you hear about Mind Garden?

    Please upload your latest CV