Men’s Support Network – Practitioner Vetting Questionnaire 1. Full Name: 2. Preferred Name (if different): 3. Email Address: 4. Phone Number: 5. Location (City, State, Country): 6. Time Zone: 7. Website or Online Profile: 8. Are you currently licensed or certified? Please include credentials and issuing body: 9. What is your primary modality or therapeutic approach? 10. How many years have you been in practice? 11. Do you currently work with male clients? If yes, what percentage? 12. Specializations (check all that apply): Trauma Divorce Recovery PTSD Fatherhood False Accusations Masculine Identity Emotional Regulation Career / Purpose Addiction or Compulsions Relationship Boundaries Other 13. Are you comfortable working exclusively with male clients? --Select-- Yes No 14. Will you refer only to male practitioners within this network? --Select-- Yes No 15. Do you support a non-feminist, male-affirming therapeutic stance? --Select-- Yes No Prefer to discuss 16. How do you see the unique emotional and mental health needs of men today? 17. Are you familiar with any of the following concepts? MGTOW Red Pill / Blue Pill Father Alienation False Accusations Feminist Policy / Court Bias 18. Have you experienced or witnessed bias against men in your field? 19. What services do you offer? (Check all that apply) In-person Sessions Remote Sessions Group Coaching/Therapy Workshops/Courses 20. What is your availability for new clients? --Select-- Immediate Within 1–2 weeks Waitlist 21. Do you offer free consultations? --Select-- Yes No 22. What is your fee range? 23. Are you open to paying a referral fee for clients we send you? --Select-- Yes No Let’s Discuss 24. Will you sign a Code of Ethics and Practitioner Agreement? --Select-- Yes No 25. What inspired you to apply? 26. Anything else we should know? Submit Application