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Community Provider Database
Basic Information

Provider Name
This value will depend on your type of practice. If your practice has a name, or you are part of a larger firm or practice, please list its name here. Otherwise, please list your name here.

Licensing

Licensing
All accepted practicitioners must be licensed to practice within the state of Florida. Your license number will be verified before your application is accepted.

Practice Information

Supported Campus(es)
Select the primary campus(es) that your practice is located near and/or is equipped to serve. Do note that most community members will use this to search for practices nearby, so please only select nearby campuses.

Questions

Sliding Scale/Student Rate
This option is mainly to assist our internal staff when making specific referrals to the community.

Insurance
If you do not see an insurance provider that you support listed, please let us know! They can be easily added at a late time to the system and to your application.

Since you selected "Yes"...
Since you selected "Yes"...
Specialties

Specialties
Please select a handful of specialties from the following specialty/interest areas. Note that the fields selected will greatly impact the search results given to the community; please only select those areas that are truly a specialty to your practice.

Religious Affiliation
Selecting either option for this question will have no bearing on your standing within the search results.

Private Information

Private:
The following is for the UCF Counseling Center only and will not be posted publicly.

Please provide us with an email address that will become your user name. Only authorized users and staff will have access to this email address and it will not be searchable. If you already have an account in the UCF CAPS Community Provider Database, reuse your current user name.

Pro-Bono Services:
Please note that if pro bono services are provided, you can attend Counseling Center professional development CEU workshops free of charge for that academic year.

Since you selected "Yes"...
Since you selected "Yes"...
Picture for Profile

Image Upload
This image will be displayed next to your search result and in your provider profile. It will be resized to a small square thumbnail. Only JPG and PNG image types are accepted.

We reserve the right to accept or reject any provider application at its discretion.