Form for CBT-E practitioners, supervisors, researchers and groups

Your name/your centre's name and your location/location of your centre:

Contact details that will appear on the CBT-E website:
(e.g. website address, email address, postal address, telephone number)

Professional Role(s) and qualifications (if relevant):
Please briefly detail your profession and/or the professions of those in your centre (e.g. Clinical Psychologist, Psychiatrist)

Training in CBT-E (if relevant):
Please detail any training in CBT-E that you and/or your members have attended (training website, workshops etc.). Please include names, dates and locations of any training attended

Clinical Practice and Supervision (if relevant):
Please provide a brief description of your clinical interests, activities and experience, and please say if you offer clinical supervision in CBT-E

Research (if relevant):
Please provide a brief description of your research interests, activities and experience and, if you wish, any publications

Email address: (required)
(Only for use by website staff, in case we require further information from you)

Photo:
Please provide a photo or image if possible of yourself/your group/centre