registration
  general info
1 - register for the program


2 - education and career history


3 - general survey


4 - counsler sessions 		 
Welcome to the Program. To get started, please complete the following online surveys. The valuable information that you provide us with will enable your counselor to learn more about you.

Note: * Required Fields
My current status is a(n):*

Please choose your username and password.
Note: You will have to re-type the same password you choose here at the bottom of this page.

Username*   Password *
 
6 to 15 characters   6 to 15 characters
First Name * MI Last Name *
E-mail Address *

Date of Birth*
(MM/DD/YYYY)

   Gender*   Ethnicity^
Address
Address Line 1:*
Address Line 2:
Address Line 3:
City: *
Postal Code: *
Home Phone: * ( )
Alternate Phone: ( )
Fax No.: ( )
State/Province:* State is not required for
international clients
Country: *
How did you learn about this program?*  

If other, please specify:

 
Retype Password
IMPORTANT: By providing us with your password in this field, you confirm that you have read and agree to our Terms & Conditions of Use, Privacy Policy, Code of Ethics, Client Waiver and Informed Consent.
I agree to the terms of the Release of Information Waiver.
^ We request this optional information regarding gender and ethnicity/ancestry in order to ensure culturally sensitive counseling.
For customer service call: 1-888-225-8248 or e-mail: helpdesk@readyminds.com

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