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Create Your Professional Profile

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Create Your Professional Profile

Please complete the form below, and we will review your information before adding you to SoberPortland.com! Thank you!

Which category best describes your business or practice?*
Select all that apply
- Therapist
- Psychiatrist
- Interventionist
- Detox
- Treatment Center
- IOP
- Sober Living
- Education
- Support Organization
Business or Practice Name:*
Primary Contact:*
Please include any relevant clinical credentials
Phone Number:*
Address:
Street Address Address Line 2 City State ZIP Code
Email:*
Website:
Which demographic group(s) do you like to serve?*
For example, mature adults, young adults, adolescents, couples, families, LGBT, etc.
Area(s) of expertise/services provided:*
For example, treatment or intervention for drug/alcohol addiction, gambling, codependency, eating disorders, process groups, aftercare groups, relapse prevention, etc.
Do you accept insurance?*
- Yes
- No
Which insurance providers do you accept?*
Interventionists, will you travel to provide services outside of the Portland area?
- Yes
- No
Do you speak any languages other than English?*
- Yes
- No
Which other language(s) do you speak?*
Additional information families or professionals should know about you:
Please upload a photo of yourself or business logo to be added to your profile:
Only .jpg, .gif, .png, and .tif file extensions will be accepted.
Accepted file types: jpg, gif, png, tif, tiff, Max. file size: 128 MB.
Please enter the text below:

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