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Therapy Matcher Online Contract
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Contract for participation in NASW-MA Chapter Therapy Matcher

I hereby request that my name be placed on the roster of Therapy Matcher for the period between July 1, 2018 and June 30, 2019.

I meet all the following eligibility requirements:

  • I am a LICSW licensed by the Massachusetts Board of Registration of Social Workers.
  • I have an established private practice in Massachusetts.
  • I am engaged in an independent private practice in which I control, for myself, the selection and billing of clients, or I am a full partner in doing so.
  • I have malpractice insurance.
  • I have 24 hour telephone coverage for my private practice. (Answering service or machine coverage is required and verified; it is expected that answering machine messages will sound professional and include provider’s name.)
  • I am able to refer clients for psychopharmacological treatment as needed.

I agree to the following:

  • I understand that when a referral is made to me, I will be sent an e mail notification, which I am required to update as instructed.
  • I agree to make use of regular clinical consultation as appropriate.
  • I will keep Therapy Matcher notified regarding my current availability for referrals.
  • I understand that enrollment in Therapy Matcher does not guarantee a referral.
  • I understand fees are to be arranged directly between providers and clients.
  • If I am unable to accept a referral, I agree to direct the client back to Therapy Matcher, not refer him/her elsewhere before conferring with Therapy Matcher staff.
  • I follow the precepts set forth in the NASW Standards for the Practice of Clinical Social Work and the NASW Code of Ethics and Massachusetts law governing social workers.
  • I will promptly notify Therapy Matcher if there is any change in my licensing status, including, but not limited to, whether I have been subject to any disciplinary action by the Massachusetts Board of Registration of Social Workers or any similar licensing Board outside of Massachusetts.
  • I understand that the decision to accept a client referred through Therapy Matcher is between the client and me and I hold NASW and the Mass Chapter harmless from any and all causes of action arising from or related to any such referral.

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Private Practice Meeting (Fall River)

National Association of Social Workers - Massachusetts Chapter
11 Beacon Street, Suite 510, Boston MA 02108
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