Provider Service Availability and Agreement

Provider participation in the Mental Wellness Support Program is exclusive to licensed resource guide members and clinical practices that offer short-term, solution-oriented, virtual therapy services.  Please view the program guidelines and complete the Provider Service Availability Agreement to support the campaign.  Please share details with any colleagues interested in creating a listing and  joining the Let’s Talk! Resource Guide.

The 2021 MWSP Provider Orientation webinar offers an overview of participant, provider and service eligibility, provider agreement, access guidelines, and the invoice process. The intended audience are licensed clinicians and their administrative or office management teams.

Step 1 of 4
Please ensure your Resource Guide listing is published. An individual practice subscription is $12.95 per month per provider (1-5 providers). A corporate subscription is $99 per month for practices with 5 providers or greater. Indicate your company / organization name on this agreement. Non-Profits are free with verified documentation.
Click or drag a file to this area to upload.
Please attach a copy of your signed W-9 form or send via e-mail to Covid19Team@borislhensonfoundation.org.