At this time we are only accepting applicants from the Austin and surrounding areas. If you are outside of this area and are still interested, please email us at and we will contact you when we start expanding our list.

Section A:


Your Name (required)

Profession (required)

Business Name (required)

Address (required)

Work Phone (required)

Cell Phone


Your Email (required)


Relevant Licenses and Certifications (required)

Section B: (All Applicants)

How Did You Hear About Us?
InternetPPHA brochure or marketing materialConferenceTrainingReferral from another individualOther

Why are you interested in becoming a provider for PPHA? What are your goals for an alliance with PPHA?

What is your experience/training working with women with Perinatal Mood Disorders (PMDs)?

What are some signs/symptoms that a person might exhibit if they are experiencing PMDs?

What do you view as the "cause" of PMDs?

What kinds of services do you offer?

What are your concerns, if any, about becoming a provider with PPHA?

Becoming a providerBecoming a memberVolunteeringAdditional training

Section C: (Clinical Providers: Psychiatrists, Physicians, Psychologists, Counselors, etc.)

What are you general treatment recommendations?

What is the difference between postpartum depression and postpartum psychosis, and how does treatment differ?

What are your views about pregnancy/breastfeeding and medication?

What is your procedure for working with a suicidal patient?

What is your training/experience in crisis management?

What is the average wait time for new patients to be seen?

Do you take insurance? Do you offer a sliding scale?

Can patients bring their babies to sessions/appointments?

How much time do you anticipate being able to devote to women with PMADs? (e.g. How many appointments per week could you dedicate? Are you willing to devote time to additional training if necessary?)