Collective Member Interest Form

Name

First Name

Last Name

License Type

Which membership type are you interested in?

Learn more about membership types:

Tier 1

Tier 2

Tier 3

Other/Undecided

Please share with us more about your practice

Why are you interested in joining a collective structure?

How do you align with our shared values? (Trauma-Informed, Identity-Affirming, Relational, Systemic)

Anticipated starting date

YYYY

Anything else helpful for us to know?

Contact Us

Middleground Mental Health Collective is a community space for mental health professionals. If you are a provider interested in a collective membership, please fill out our Member Interest Form to explore next steps.

If you are interested in mental health services, please contact providers directly using their websites and contact information linked on the Directory Page.

For all other inquiries, please complete our general contact form here or reach out using one of the contact methods below.

We look forward to hearing from you!

Phone: (512) 361-9797

Email: admin@middlegroundmentalhealth.com